The role of procalcitonin in identifying high‐risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score

Chaftari, Patrick; Chaftari, Anne-Marie; Hachem, Ray; Yeung, Sai Ching Jim; Dagher, Hiba; Jiang, Ying; Malek, Alexandre; Garnes, Natalie Dailey; Mulanovich, Victor E.; Raad, Issam

doi:10.1002/cam4.4355

Cited by 8 publications

(12 citation statements)

References 35 publications

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“… 31 , 32 , 33 Previously determined PCT thresholds, diagnostic accuracy, and predictive performance have varied by immune status, disease state, patient population, clinical presentation, outcome studied, and test used. 16 , 19 , 20 , 25 , 26 , 27 , 28 , 34 , 35 The cutoff of 0.4 ng/mL determined in our study differs from the 0.25 ng/mL that is commonly used for community‐acquired bacterial pneumonia. 21 Additionally, it is lower than the cutoff value of 1.5 ng/mL that demonstrated utility in diagnosing bacterial infections in patients undergoing hemodialysis.…”

Section: Discussioncontrasting

confidence: 67%

“…18 , 19 , 20 , 21 , 22 , 23 Typically, PCT levels begin rising within 3–4 h of bacterial infection and usually peak between 12 and 36 h. 17 Additionally, serum PCT monitoring has been found to successfully predict infection, particularly bacteremia, in patients with hematological malignancies. 24 , 25 , 26 , 27 , 28 Lastly, longitudinal serum PCT monitoring can facilitate antibiotic discontinuation without compromising patient safety. 29 , 30 …”

Section: Introductionmentioning

confidence: 99%

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Procalcitonin as a biomarker for predicting bacterial infection in chimeric antigen receptor T‐cell therapy recipients

et al. 2023

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Background It is unknown whether serum procalcitonin (PCT) concentration monitoring can differentiate between bacterial infection or cytokine release syndrome (CRS) when chimeric antigen receptor T‐cell (CAR‐T) recipients present with a constellation of signs and symptoms that may represent both complications. Objective The objective of the study was to assess the utility of serum PCT concentrations as a biomarker of bacterial infection in CAR‐T recipients. Study design This single‐center, retrospective, medical record review evaluated patients prescribed CAR‐T therapy until death or 30 days after infusion. Logistic regression modeling determined the association between elevated serum PCT concentrations within 48 h of fever onset and microbiologically confirmed infection. Secondary outcomes included clinically suspected infection, CAR‐T toxicity rates, and broad‐spectrum antibiotic usage. Predictive performance of PCT was assessed by area under the receiver operating characteristic curve (AUC). Results The 98 included patients were a median age of 63 (IQR: 55–69) years old, 47 (48%) were male, and 87 (89%) were Caucasian. Baseline demographics and clinical characteristics were similar between patients with and without a bacterial infection. Serum PCT >0.4 ng/mL within 48 h of fever was significantly associated with a microbiologically confirmed bacterial infection (OR: 2.75 [95% CI: 1.02–7.39], p = 0.045). Median PCT values in patients with and without confirmed infections were 0.40 ng/mL (IQR: 0.26, 0.74) and 0.26 ng/mL (IQR: 0.13, 0.47), respectively. The AUC for PCT to predict bacterial infection was 0.62 (95% CI 0.48–0.76). All patients experienced CRS of some grade, with no difference in CRS severity based on elevated PCT. Broad‐spectrum antibiotics were used for a median of 45% and 23% of days in those with and without confirmed infection, respectively ( p = 0.075). Conclusion Elevated serum PCT concentrations above 0.4 ng/mL at time of first fever after CAR‐T infusion was significantly associated with confirmed bacterial infection. Furthermore, rigorous, prospective studies should validate our findings and evaluate serial PCT measurements to optimize antimicrobial use after CAR‐T therapy.

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Section: Discussioncontrasting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Procalcitonin as a biomarker for predicting bacterial infection in chimeric antigen receptor T‐cell therapy recipients

et al. 2023

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“…Our finding that the rate of microbiologically documented bacterial co-infections from any source, including blood, lower respiratory tract, and urine, was lower in patients with PCT < 0.25 ng/ml is consistent with well-established findings that pure viral infections are unlikely to increase PCT levels 21 . Furthermore, both in the general population 1,2,4,9-11 and in immunocompromised patients 5-8 , patients with low PCT levels are unlikely to have bacterial infections. PCT levels increase in patients with many types of bacterial infections, including bacterial infections of the lower respiratory tract 22 , bacterial meningitis 23 , acute pyelonephritis 24 , spontaneous bacterial peritonitis 25 , and bloodstream bacterial infections 26 .…”

Section: Discussionmentioning

confidence: 99%

“…Several PCT cut-off values have been evaluated and used in different treatment algorithms. PCT cut-off values of 0.25 ng/ml and 0.5 ng/ml have been adopted for critically ill patients in the intensive care unit (ICU) 12 , neutropenic patients 2,3,8 , and patients with lower respiratory tract infections 13 .…”

Section: Introductionmentioning

confidence: 99%

“…These factors have proved valuable for determining prognosis and have guided the treatment of patients at risk for severe COVID-19. Procalcitonin (PCT) is a biomarker that has served as an indicator for bloodstream infections and has been used as a guide to antimicrobial management in sepsis and bacterial infections in the general population 1-4 and in cancer patients with and without neutropenia 5-8 . Randomized trials have shown PCT to be useful in guiding decisions regarding antimicrobial therapy for lower respiratory tract infections 9-11 .…”

Section: Introductionmentioning

confidence: 99%

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Procalcitonin for Antimicrobial Stewardship Among Cancer Patients Admitted with COVID-19

Dagher

Chaftari

Mulanovich

et al. 2022

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Background: Procalcitonin (PCT) has been used to guide antibiotic therapy in bacterial infections. We aimed to determine the role of PCT in decreasing the duration of empiric antibiotic therapy among cancer patients admitted with COVID-19. Methods: This retrospective study included cancer patients admitted to our institution for COVID-19 between March 1, 2020, and June 28, 2021, with a PCT test done within 72 hours after admission. Patients were divided into 2 groups: PCT <0.25 ng/ml and PCT ≥0.25 ng/ml. We assessed pertinent cultures, antibacterial use, and duration of empiric antibacterial therapy. Results: The study included 530 patients (median age, 62 years [range, 13-91]). All the patients had ≥1 culture test within 7 days following admission. Patients with PCT <0.25 ng/ml were less likely to have a positive culture than were those with PCT ≥0.25 ng/ml (6% [20/358] vs 17% [30/172]; p<0.0001). PCT <0.25 ng/ml had a high negative predictive value for bacteremia and 30-day mortality. Patients with PCT <0.25 ng/ml were less likely to receive intravenous (IV) antibiotics for >72 hours than were patients with PCT ≥0.25 ng/ml (45% [162/358] vs 69% [119/172]; p<0.0001). Among patients with PCT <0.25 ng/ml and negative cultures, 30-day mortality was similar between those who received IV antibiotics for ≥72 hours and those who received IV antibiotics for shorter durations (2% [2/111] vs 3% [5/176], p=0.71). Conclusions: Among cancer patients with COVID-19, PCT level <0.25 ng/ml is associated with lower likelihood of bacterial co-infection and greater likelihood of a shorter antibiotic course. In patients with PCT level <0.25 ng/ml and negative cultures, an antibiotic course of > 72 hours is unnecessary. PCT could be useful in enhancing antimicrobial stewardship in cancer patients with COVID-19.

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