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. 2022 Apr 25:13:843067.
doi: 10.3389/fimmu.2022.843067. eCollection 2022.

The Clinical Value of Procalcitonin in the Neutropenic Period After Allogeneic Hematopoietic Stem Cell Transplantation

Meng Shan  1   2   3   4 , Danya Shen  1   2   3   4 , Tiemei Song  1   2   4 , Wenyan Xu  1   2   4 , Huiying Qiu  1   2   4 , Suning Chen  1   2   4 , Yue Han  1   2   4 , Xiaowen Tang  1   2   4 , Miao Miao  1   2   4 , Aining Sun  1   2   4 , Depei Wu  1   2   3   4 , Yang Xu  1   2   3   4
Affiliations

The Clinical Value of Procalcitonin in the Neutropenic Period After Allogeneic Hematopoietic Stem Cell Transplantation

Meng Shan et al. Front Immunol. .

Abstract

The diagnostic value of procalcitonin and the prognostic role of PCT clearance remain unclear in neutropenic period after allogeneic hematopoietic stem cell transplantation introduction. This study evaluated 219 febrile neutropenic patients (116, retrospectively; 103, prospectively) who underwent allo-HSCT from April 2014 to March 2016. The area under the receiver operator characteristic curve (AUC) of PCT for detecting documented infection (DI) was 0.637, and that of bloodstream infection (BSI) was 0.811. In multivariate analysis, the inability to decrease PCT by more than 80% within 5-7 days after the onset of fever independently predicted poor 100-day survival following allo-HSCT (P = 0.036). Furthermore, the prognostic nomogram combining PCTc and clinical parameters showed a stable predictive performance, supported by the C-index of 0.808 and AUC of 0.813 in the primary cohort, and C-index of 0.691 and AUC of 0.697 in the validation cohort. This study demonstrated the diagnostic role of PCT in documented and bloodstream infection during the neutropenic period after allo-HSCT. PCTc might serve as a predictive indicator of post-HSCT 100-day mortality. A nomogram based on PCTc and several clinical factors effectively predicted the 100-day survival of febrile patients and may help physicians identify high-risk patients in the post-HSCT neutropenic period.

Keywords: allogeneic hematopoietic stem cell transplantation; infectious disease; nomogram; procalcitonin; prognosis.

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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
The study profile.
Figure 2
Figure 2
(A). The onset value of procalcitonin in 130 febrile events in the neutropenic period after allogeneic hematopoietic stem cell transplantation. (B) Comparison of the onset PCT value among the three groups: fungal infection, bacterial infection, and noninfectious events. (C) The diagnostic value of procalcitonin for documented infection. (D) The diagnostic value of procalcitonin for documented infection. (E) The diagnosis of 130 febrile events. (F) The spectrum of pathogens in 26 positive blood cultures.
Figure 3
Figure 3
Survival outcome for 116 febrile patients in the neutropenic period after allo-HSCT according to PCTc. (A) aGVHD-free survival; (B) III–IV aGVHD cumulative incidence; (C) overall survival; and (D) 100-day survival.
Figure 4
Figure 4
(A) Nomogram with PCTc for predicting the 100-day survival of febrile patients in the neutropenic period after allo-HSCT. (B) Nomogram without PCTc for predicting the 100-day survival of febrile patients in the neutropenic period after allo-HSCT. (C, D) Calibration curve of nomogram with or without PCTc for predicting patient survival at 100 days in the primary (C) and validation cohort (D). (E, F) ROC curve of nomogram with or without PCTc for the predicted 100-day survival based on the nomogram in the primary (E) and validation cohort (F). (G, H) 100-day survival according to the nomogram score of nomogram with PCTc in the primary (G) and validation cohort (H). (I, J) 100-day survival according to the nomogram score without PCTc in the primary (I) and validation cohort (J).
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