| Title: |
Utility of procalcitonin and C-reactive protein as predictors of Gram-negative bacteremia in febrile hematological outpatients. |
| Authors: |
Jabbour, Jean Pierre1, Ciotti, Giulia1, Maestrini, Giacomo1, Brescini, Mattia1, Lisi, Chiara1, Ielo, Claudia1, La Pietra, Gianfranco1, Luise, Cristina1, Riemma, Costantino1, Breccia, Massimo1, Brunetti, Gregorio Antonio1, Carmosino, Ida1, Latagliata, Roberto1, Morano, Giacomo Salvatore1, Martelli, Maurizio1, Girmenia, Corrado1 girmenia@bce.uniroma1.it |
| Source: |
Supportive Care in Cancer. May2022, Vol. 30 Issue 5, p4303-4314. 12p. |
| Subject Terms: |
*C-reactive protein, *BACTEREMIA, *FEVER, *PREDICTIVE tests, *CONFIDENCE intervals, *CALCITONIN, *CANCER patients, *HEMATOLOGIC malignancies, *DESCRIPTIVE statistics, *GRAM-negative bacterial diseases, *RECEIVER operating characteristic curves |
| Abstract: |
This study was designed to determine the utility of procalcitonin (PCT) and C-reactive protein (CRP) as predictors of Gram-negative bloodstream infection (GN-BSI) in hematological febrile outpatients at the time of the emergency unit admission. Overall, 286 febrile episodes, which included 42 GN-BSI (16%), were considered. PCT levels at patient admission were statistically higher in GNB-BSI when compared to Gram-positive bacteria BSI (median 4.06 ng/ml (range 1.10–25.04) vs 0.88 ng/ml (0.42–10), p<0.03) and to all other fever etiologies. For CRP, differences within fever etiologies were less profound but statistically significant, except for GN-BSIs vs GP BSIs (p=0.4). ROC analysis of PCT showed that an AUC of 0.85 (95%CI 0.79–0.95) discriminated GN-BSI from all other fever etiologies, with a best cut-off of 0.5 ng/ml, a negative predictive value (NPV) of 98%, and a negative likelihood ratio (negLR) of 0.1. ROC analysis of CRP showed an AUC of 0.67 (95%CI 0.53–0.81) with a best cut-off of 6.64 mg/dl, a NPV of 94%, and a negLR of 0.33. This study confirms that 0.5 ng/ml represents the PCT best cut-off to differentiate the cause of fever and rule out a GN-BSI in febrile hematologic outpatients at the time of the emergency unit admission. Therefore, introducing PCT testing could be a valid measure in order to tailor a more precise prompt antimicrobial therapy to the febrile outpatient while waiting for blood culture results. [ABSTRACT FROM AUTHOR] |
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