Comparison of CRP and procalcitonin for etiological diagnosis of fever during febrile neutropenia in hematology patients- an experience from a tertiary care center in Northern India

• Published in: Blood cells, molecules, & diseases Vol. 84; p. 102445
• Main Authors: Halder, Rohan, Seth, Tulika, Chaturvedi, Pradeep K., Mishra, Priyanka, Mahapatra, Manoranjan, Pati, Hara P., Tyagi, Seema, Saxena, Renu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2020
• Subjects: Adolescent; Adult; Biomarkers - blood; C reactive protein; C-Reactive Protein - analysis; Febrile neutropenia; Febrile Neutropenia - blood; Febrile Neutropenia - diagnosis; Febrile Neutropenia - etiology; Female; Fever - blood; Fever - diagnosis; Fever - etiology; Hematologic Neoplasms - complications; Humans; India - epidemiology; Invasive fungal infections; Male; Mycoses - complications; Procalcitonin; Procalcitonin - blood; Prospective Studies; Tertiary Care Centers; Young Adult; India; CRP; PCT; Procalcitonin; ICHS; FN; CDI; LPS; ESMO; IFI/IFD; MDI; PUO/FUO; ANC; C reactive protein; Hr/Hrs; Invasive fungal infections; Febrile neutropenia
• ISSN: 1079-9796; 1096-0961
• DOI: 10.1016/j.bcmd.2020.102445

Febrile neutropenia is a common cause in morbidity and mortality during treatment of hematological neoplasms.
Subjects included all cases admitted under hematology department with febrile neutropenia from February to June 2018. Each febrile episode was investigated by standard investigations (Blood culture, Chest x ray etc.); Procalcitonin (PCT) and c reactive protein (CRP) was sent at fever onset 0, 24, 48 h, day 7 and day 14.
Data was analyzed for 52 febrile episodes in 50 patients. PCT cut off value at 24 h of ≤1.2 ng/ml had a sensitivity and specificity of 62.5% and 87.5% for discriminating Invasive fungal infection (IFI) and Microbiologically documented infection (MDI) (p = 0.033). PCT had a negative predictive value of 70% for the diagnosis of IFI as compared to MDI. CRP cut off >160 mg/dl at 48 h was suggestive of fever due to fungal infection with a sensitivity of 100%, specificity of 48%, PPV of 33.3% and NPV of 100%. CRP at 24 and 48 h of fever was useful to distinguish non-infectious causes of fever from infectious causes.
PCT at 24 h and CRP at 48 h was useful in identifying fungal infection. CRP was a better marker when compared to PCT for identifying disease fever.
•Procalcitonin (PCT) and c reactive protein (CRP) was sent at fever onset 0, 24 , 48h, day 7 and day 14 of the febrile episode•PCT cut off value at 24 h [1–21] of ≤1.2ng/ml had a sensitivity and specificity of 62.5% and 87.5% for discriminating Invasive fungal infection (IFI) and Microbiologically documented infection (MDI).•PCT had a negative predictive value of 70% for the diagnosis of IFI as compared to MDI.•CRP cut off >160mg/dl at 48 h was suggestive of fever due to fungal infection.