C-reactive protein, procalcitonin and interleukin-8 in the primary diagnosis of infections in cancer patients
Introduction
Procalcitonin (PCT), a 116 amino acid propeptide of calcitonin, has been proposed as a new diagnostic marker of severe infections [1], such as neonatal infections 2, 3, septic shock 4, 5 and bacterial meningitis [6] as well as pyelonephritis amongst children [7]. In normal individuals, calcitonin and PCT are produced by C-cells of the thyroid gland, but the reason for increased PCT secretion in patients with severe infections is not known [1]. Enhanced production of calcitonin-like peptides or calcitonin-precursor peptides is also seen in patients with different malignancies [8] PCT has been shown to be a promising indicator for bacteraemia, even in neutropenic patients with haematological malignancies 9, 10, 11.
Interleukin-8 (IL-8) is an important chemotactic regulator of neutrophil function in vivo 12, 13. Its concentration increases during different infections, such as bacteraemia [14] and meningococcal disease [15]. High IL-8 concentrations have also been demonstrated in association with malignancies 16, 17. In neutropenic patients, enhanced IL-8 production has been demonstrated comparable with PCT in predicting bacteraemia [11].
C-reactive protein (CRP) is the most widely used marker of ongoing infection in clinical practice 18, 19. The use of CRP values to diagnose infection in cancer patients is often difficult, because the underlying malignancy also induces CRP production in hepatocytes 19, 20. Actually, the activation of an acute-phase response is regarded as prognostic in oncology 21, 22, 23.
The purpose of our prospective study was to assess whether PCT and IL-8 are more useful than CRP to identify infection in non-neutropenic cancer patients, which would help to avoid unnecessary antibiotic treatment as well as hospitalisation.
Section snippets
Study design for the identification of study groups
The study protocol was approved by the Ethics Review Committee of the Medical Faculty of the University of Oulu, Oulu, Finland. Between September 1996 and March 1998, 92 consecutive cancer patients with suspected infection and Karnofsky performance scores higher than 40 were enrolled in this prospective study at the Department of Oncology and Radiotherapy, Oulu University Hospital, Finland. When the oncologist in charge suspected infection, oral and written informed consent was obtained from
Results
26 of the 92 patients (28%) with suspected infection did not meet the abovementioned classification criteria. In these cases, simultaneous antibiotic and cancer treatments did not allow classification, and these 26 patients were therefore excluded from the study. From the remaining 66 cancer patients, 56 had the following infections: 8 had bacteraemia (3 had Staphylococcus aureus, and 1 each Escherichia coli, Pasteurella multocida, Clostridium bifermentans, another gram-negative anaerobic rod
Discussion
Our results show that the discriminatory power of PCT amongst cancer patients was best for bacteraemia with an AUC value of 0.92, whilst its ability to discriminate minor infections from neoplastic fever was less good with an AUC value of 0.56. In contrast, the AUCs of CRP and IL-8 were poor for both bacteraemia and other infections in this population with solid tumours, of whom most were non-neutropenic and non-bacteraemic. Thus, our study population differs from those previously reported,
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Cited by (52)
Novel potential biomarkers for pancreatic cancer – A systematic review
2019, Advances in Medical SciencesCitation Excerpt :Then we excluded 335 articles not containing data useful for our analysis. As a result, there remained 72 full-text articles assessed for eligibility, including: 11 publications concerned the issue of PC [1–11], 5 papers were about inflammation processes in cancer [12–16], 20 studies regarded chemokines and their specific receptors [16,22–40], 15 publications presented information about IL-6 and CRP [17,18,41–53], 10 papers dealt with hematopoietic cytokines [19,20,54–61], 9 studies involved MMPs and their tissue inhibitors [21,62–69], 2 articles were about proteomics [70,71]. In the final step, we excluded all review papers, and so 35 original publications were included in the study.
Is the level of serum procalcitonin a determinant for the prescription of antibiotics in case of suspicion of superinfected influenza-like syndrome in geriatrics ?
2019, NPG Neurologie - Psychiatrie - GeriatrieValidity of procalcitonin for the diagnosis of bacterial infection in elderly patients
2015, Enfermedades Infecciosas y Microbiologia ClinicaCitation Excerpt :Nonetheless one quickly extrapolates the use of these diagnostic tests to this age group. Some diseases such as ischemic heart disease, heart failure (HF) and tumors can cause high levels of PCT in blood in absence of infection8,9; Therefore, considering that these illnesses are very common in elderly patients, it is important to carry out specific studies in elderly population in order to determine whether PCT can be used as a reliable tool for the diagnosis of bacterial infections and sepsis, as demonstrated in the general population. Thus, the aim of our study is to establish whether the cut off of PCT (established 0.5 ng/ml) is also valid for the diagnosis of bacterial infection in the elderly population as it has been applied in the general population.
Usefulness of procalcitonin for predicting bacteremia in cancer patients with fever
2014, Revista del Laboratorio ClinicoThe diagnostic role of Procalcitonin and other biomarkers in discriminating infectious from non-infectious fever
2010, Journal of InfectionCitation Excerpt :The value of CRP in differentiating infectious from non-infectious fever in neutropenic patients has been studied extensively. It has repeatedly been shown that CRP is an unreliable marker of bacterial infection in this patient group.56–58 A recent systematic review identifies PCT as a valuable tool in determining the etiology of fever in neutropenic patients, with elevated levels of circulating PCT in patients with bacterial fever.10