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. 2023 Jul;149(8):5193-5204.
doi: 10.1007/s00432-022-04419-x. Epub 2022 Nov 13.

The utility of procalcitonin for diagnosing bacteremia and bacterial pneumonia in hospitalized oncology patients

Mary K Munsell  1 , Temidayo Fadelu  1   2   3 , Sherri O Stuver  2   4 , Katherine P Baker  1   3 , Brett Glotzbecker  1   2   3 , Justin L Simmons  1   2   3 , Kerry L Reynolds  1   5 , Ami K Patel  6   7   8
Affiliations

The utility of procalcitonin for diagnosing bacteremia and bacterial pneumonia in hospitalized oncology patients

Mary K Munsell et al. J Cancer Res Clin Oncol. 2023 Jul.

Abstract

Purpose: Procalcitonin (PCT) is an inflammatory marker elevated in bacteremia and bacterial pneumonia. We aimed to assess the real-world diagnostic accuracy of PCT in hospitalized patients with malignancy.

Methods: A retrospective cohort of 715 patients with cancer who had PCT measured during 750 admissions was analyzed. Diagnosis of bacteremia was determined using blood culture data. Diagnosis of bacterial pneumonia was based on radiographic infiltrate and/or sputum culture. PCT's performance was assessed using receiver operating characteristic (ROC) curves, sensitivity, and specificity.

Results: Patients had bacteremia, bacterial pneumonia, or both during 210 admissions (28%). PCT elevation above 0.5 ng/mL was significantly associated with diagnosed infection in the overall population (p < 0.0001) and in subgroups with solid tumor malignancies (p < 0.0001) and hematologic malignancies (p = 0.008). PCT was associated with infectious status in patients with any metastases, but not those with primary lung cancer, lung metastases, neuroendocrine tumors, febrile neutropenia, or history of bone marrow transplant (BMT). The area under the ROC curve for PCT in the overall population was 0.655. An ideal cutoff of 0.21 ng/mL led to a sensitivity of 60% and specificity of 59%. At cutoffs of 0.5 ng/mL and 0.05 ng/mL, PCT's sensitivity was 39% and 94%, while specificity was 79% and 17%, respectively.

Conclusion: In this large cohort of hospitalized oncology patients, PCT elevation was associated with diagnosed bacteremia and/or bacterial pneumonia. However, specificity was limited, and PCT elevation was not associated with diagnosed infection in some subpopulations. While PCT may have some diagnostic utility for hospitalized oncology patients, values must be interpreted cautiously and considering clinical context.

Keywords: Bacteremia; Diagnostic marker; Inpatient; Oncology; Pneumonia; Procalcitonin.

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Conflict of interest statement

The authors declare that they have no relevant financial or non-financial interests to disclose. The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of patients and encounters included and excluded from the study. * = patients, † = admissions; PCT procalcitonin
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curves for procalcitonin in a The overall study population, b Patients with solid tumor malignancies, and c Patients with hematologic malignancies. AUC  area under the curve
Fig. 3
Fig. 3
Box and whisker plots demonstrating the distribution of procalcitonin (PCT) values by negative or positive bacteremia or bacterial pneumonia diagnostic status, based on blood culture, radiography, and sputum culture. ln  natural logarithm
See this image and copyright information in PMC

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