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Observational Study
. 2025 Nov;8(11):e70384.
doi: 10.1002/cnr2.70384.

Diagnostic Accuracy of Procalcitonin in the Diagnosis of Sepsis in Cancer Patients Hospitalized for Infection

Veronica Salvatore  1 , Antonella Viola  1 , Alessandra Spezzano  1 , Alessandra Aquilino  1 , Lorenzo Barili  1 , Mariapia Caprino  1 , Maria Floresta  1 , Giulia Momoli  1 , Alessandra Romiti  1 , Giulia Scurria  1 , Martina Sirna  1 , Alexandro Paccapelo  2 , Margherita Nannini  3   4 , Andrea Ardizzoni  3   4 , Fabrizio Giostra  1
Affiliations
Observational Study

Diagnostic Accuracy of Procalcitonin in the Diagnosis of Sepsis in Cancer Patients Hospitalized for Infection

Veronica Salvatore et al. Cancer Rep (Hoboken). 2025 Nov.

Abstract

Objectives: Sepsis is defined as a life-threatening, dysfunctional body-response to infection. Procalcitonin (PCT) is considered a marker of sepsis due to bacterial infections and it has been extensively used as a guide to antimicrobial management in the general population. The clinical role of PCT in cancer patients admitted to the Emergency Department (ED) for infection is still little researched.

Methods: A prospective observational study enrolling all adult patients hospitalized for infection referred to the ED of IRCCS Azienda Ospedaliero-Universitaria di Bologna between February 1st, 2023 and July 31st, 2023 was conducted. The primary endpoint was to evaluate the accuracy of PCT in the diagnosis of sepsis (defined according to the latest guidelines) in patients with cancer in comparison to non-cancer patients.

Results: 1041 out of 1125 eligible patients were enrolled (559 males and 482 females), out of whom 289 (27.8%) had active cancer. PCT levels differed between cancer and non-cancer patients (1 ng/mL with IQR 5.85 vs. 0.6 ng/mL with IQR 2.7; p < 0.001). The AUROC of PCT for the diagnosis of sepsis in the entire enrolled population was 0.717 (95% CI 0.683-0.745), whereas it was 0.655 (95% CI 0.592-0.718) in cancer patients and 0.743 (95% CI 0.708-0.778) in non-cancer patients (p = 0.016). A PCT cut-off of 0.5 ng/mL (PCT ≥ 0.5 ng/mL) confirmed its accuracy for predicting sepsis in non-cancer patients (sensitivity 71.5%, specificity 64.1%) but the specificity fell to 44.7% in cancer patients, although sensitivity remained good (sensitivity 78.9%). Conversely, a higher PCT cut-off of 1 ng/mL, as the most accurate threshold identified in the present study in the cancer population, showed a sensitivity of 66.9% and specificity of 61.2% in predicting sepsis in cancer patients.

Conclusion: Our study confirms the clinical role of PCT as a part of the diagnostic algorithm for sepsis but its diagnostic role is sub optimal in cancer patients.

Keywords: cancer; diagnosis; procalcitonin; sepsis; sofa score.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Procalcitonin AUROC plot for cancer (red line) and non‐cancer (blue line) patients.
FIGURE 2
FIGURE 2
Procalcitonin levels according to the presence of sepsis and cancer. Left box plots represent patients without sepsis and right box plots patients with sepsis, according to the presence of active cancer (light blue) or not (green).
FIGURE 3
FIGURE 3
Procalcitonin levels according to the presence of metastases in patients without sepsis and with sepsis. Left box plots represent procalcitonin levels in patients without sepsis and right box plots represent procalcitonin levels in patients with sepsis according to the presence of metastatic cancer (light blue) or not (green) metastatic cancer.
See this image and copyright information in PMC

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