Utility of blood procalcitonin concentration in the management of cancer patients with infections

Abstract

Diagnosis of infections in cancer patients is usually problematic since differentiating between infection and fever of unknown origin is often a considerable clinical challenge. In general, increase concentration of blood procalcitonin (PCT) is associated with severe bacterial infection. PCT with an optimal cutoff level of 0.5 ng/mL seems to be the most helpful biochemical parameter in detecting severe infections, mainly bloodstream infection, in patients with hematological cancers. In all clinical situations, the elevated level of PCT should be carefully analyzed, always with a thorough physical examination and an appropriate microbiological assessment.

Keywords: cancer; infection; procalcitonin.

Figure 1

Secretion and biological function of PCT in physiological and pathological stage (A). Differentiation fold increase in PCT level among patients who developed a cancer with or without fever or/and microbiological infection (B). Notes: Median of PCT level: 0.029 – noncancer patients; 0.099 – patients with cancer without fever; 0.310 – patients with cancer and fever without microbiological infection; 0.490 – patients with cancer and fever with bacteremia/sepsis. Adapted from Chaftari AM, Hachem R, Reitzel R, et al. Role of procalcitonin and interleukin-6 in predicting cancer, and its progression independent of infection. PLoS One. 2015;10(7):e0130999. Abbreviations: PCT, procalcitonin; ROS, reactive oxygen species.