Utility of procalcitonin as a predictor of bloodstream infections and supportive modality requirements in critically ill cancer patients Journal Article


Authors: Blouin, A. G.; Hsu, M.; Fleisher, M.; Ramanathan, L. V.; Pastores, S. M.
Article Title: Utility of procalcitonin as a predictor of bloodstream infections and supportive modality requirements in critically ill cancer patients
Abstract: Background: We evaluated the diagnostic utility of procalcitonin (PCT) in predicting bacterial bloodstream infections (BSI) in critically ill cancer patients with and without neutropenia. We also investigated the role of PCT as a prognostic marker of supportive modalities (vasopressors, invasive mechanical ventilation, and renal replacement therapy (RRT)) in the intensive care unit (ICU). Methods: We retrospectively analyzed 2200 PCT and blood cultures from adult cancer patients with suspected sepsis. Primary outcome was BSI, defined by positive blood culture, collected within 72 h of PCT collection. Results: Median PCT values were higher in encounters with BSI (3.2 vs 0.5 ng/ml, p < 0.001). The area under the ROC curve (AUC) was 0.726 (95%CI 0.698, 0.754). PCT > 2.0 ng/ml was significantly associated with greater likelihood of BSI and this effect was significantly stronger for neutropenic (OR 9.09, 95%CI: 4.39, 18.79) compared with non-neutropenic patients (OR 4.00 (95% CI: 3.13, 5.10), interaction p = 0.036). PCT > 2.0 was associated with vasopressor requirement on ICU admission (OR 1.82 (95% CI 1.31, 2.53), p < 0.001) and RRT (OR 2.20 (95% CI 1.24, 3.91), p = 0.007). Conclusions: Procalcitonin is a fair discriminator of BSI in critically ill cancer patients with and without neutropenia and a PCT > 2.0 ng/ml was significantly more likely to require vasopressors and RRT in the ICU. © 2020 Elsevier B.V.
Keywords: adult; controlled study; aged; major clinical study; neutropenia; disease marker; cancer patient; outcome assessment; sensitivity and specificity; biomarkers; protein blood level; disease association; cohort analysis; retrospective study; intensive care unit; sepsis; hospital admission; bloodstream infection; protein determination; predictive value; receiver operating characteristic; hypertensive factor; artificial ventilation; reference value; critically ill patient; diagnostic test accuracy study; blood culture; invasive procedure; renal replacement therapy; procalcitonin; cancer; prognosis; human; male; female; priority journal; article
Journal Title: Clinica Chimica Acta
Volume: 510
ISSN: 0009-8981
Publisher: Elsevier Science BV  
Date Published: 2020-11-01
Start Page: 181
End Page: 185
Language: English
DOI: 10.1016/j.cca.2020.07.024
PUBMED: 32679129
PROVIDER: scopus
PMCID: PMC7572786
DOI/URL:
Notes: Article -- Export Date: 3 August 2020 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Meier Hsu
    150 Hsu
  2. Stephen Pastores
    187 Pastores
  3. Martin Fleisher
    301 Fleisher
  4. Amanda Germaine Blouin
    5 Blouin