Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 12:8:627967.
doi: 10.3389/fmed.2021.627967. eCollection 2021.

Procalcitonin and C-Reactive Protein/Procalcitonin Ratio as Markers of Infection in Patients With Solid Tumors

Matteo Vassallo  1 , Celine Michelangeli  1 , Roxane Fabre  2 , Sabrina Manni  1 , Pierre L Genillier  3 , Nicolas Weiss  1 , Elea Blanchouin  1 , Laurence Saudes  1 , Regis Kaphan  1 , Annick Puchois  4 , Christian Pradier  2 , Nathalie Montagne  1
Affiliations

Procalcitonin and C-Reactive Protein/Procalcitonin Ratio as Markers of Infection in Patients With Solid Tumors

Matteo Vassallo et al. Front Med (Lausanne). .

Abstract

Objectives: The roles of procalcitonin (PCT) and C-reactive protein (CRP) in febrile cancer patients is currently unclear. Our aim was to assess these in febrile patients with solid tumors and to identify cut-off values for ruling out infection. Methods: We retrospectively evaluated patients with solid tumors admitted to hospital due to fever. They were divided into those with Fever with microbiologically documented infection (FMDI), Fever with clinically documented infection (FCDI) and Tumor-related fever (TRF). PCT and CRP levels were compared. Receiver-operating curves were plotted to define the best cut-off values for discriminating between infection-related and cancer-related fever. Results: Between January 2015 to November 2018, 131 patients were recorded (mean age 68 years, 67% male, 86% with metastasis). Patients with FMDI or FCDI had significantly higher baseline levels of PCT and lower CRP/PCT than those with TRF. A PCT cut-off value of 0.52 ng/mL for discriminating between infection and cancer-associated fever yielded 75% sensitivity, 55% specificity, 77% positive predictive value (PPV), and 52% negative predictive value (NPV). A CRP/PCT ratio with a cut-off value of 95 showed 56% sensitivity, 70% specificity, 79% NPV, and 44% PPV. Discussion: PCT is a sensitive marker of sepsis or localized infection in patients with solid tumors, but its specificity is poor. The CRP/PCT ratio improves specificity, thus providing a reliable means of ruling out infection for values above 95.

Keywords: C-reactive protein/procalcitonin ratio; fever; infection; procalcitonin; solid tumor.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Receiver operating characteristics curve for CRP/PCT ratio and PCT at inclusion.
See this image and copyright information in PMC

References

    1. Durnaś B, Watek M, Wollny T, Niemirowicz K, Marzec M, Bucki R, et al. . Utility of blood procalcitonin concentration in the management of cancer patients with infections. Onco Targets Ther. (2016) 9:469–75. 10.2147/OTT.S95600 - DOI - PMC - PubMed
    1. Dusemund F, Bucher B, Meyer S, Thomann R, Kühn F, Bassetti S, et al. . Influence of procalcitonin on decision to start antibiotic treatment in patients with a lower respiratory tract infection: insight from the observational multicentric ProREAL surveillance. Eur J Clin Microbiol Infect Dis. (2013) 32:51–60. 10.1007/s10096-012-1713-8 - DOI - PubMed
    1. Townsend J, Adams V, Galiatsatos P, Pearse D, Pantle H, Masterson M, et al. . Procalcitonin-guided antibiotic therapy reduces antibiotic use for lower respiratory tract infections in a United States medical center: results of a clinical trial. Open Forum Infect Dis. (2018) 5:ofy327. 10.1093/ofid/ofy327 - DOI - PMC - PubMed
    1. Jiang R, Han B, Dou C, Zhou F, Cao B, Li X. Analysis of antibiotic usage for viral community-acquired pneumonia in adults. Front Med. (2020) 13:1–5. 10.1007/s11684-019-0736-2 - DOI - PMC - PubMed
    1. Nakajima A, Yazawa J, Sugiki D, Mizuguchi M, Sagara H, Fujisiro M, et al. . Clinical utility of procalcitonin as a marker of sepsis: a potential predictor of causative pathogens. Intern Med. (2014) 53:1497–503. 10.2169/internalmedicine.53.1785 - DOI - PubMed