PROCALCITONIN IN PATIENTS WITH CANCER: ROLE OF BIOMARKER-ASSISTED DIAGNOSIS ECCMI-2222

FOR BACTERIAL INFECTIONS, SIRS AND SEPSIS SYNDROME Biomarkers

J. Torres Isasiga1, J. Teperman1, Y. Dubrovskaya2, R. Press1, A. Safdar1
1Medicine, Pharmacy2; NYU Langone Medical Center, New York, USA

Introduction Table 1. Demographics and underlying conditions in cancer and non-cancer patients
Figure 1. Procalcitionin (PCT) values among different SIRS categories
• Bacterial infections and sepsis are difficult to distinguish from non-infectious
causes of fever in cancer patients. Cancer (n=103) Non-Cancer (n=239) P value
Patient characteristics n (%) n (%)
• The use of specific biomarkers may reduce delays in establishing correct diagnoses
and facilitate initiation of appropriate therapy.
Male gender 50 (48.5) 131 (54.8) 0.34
• Procalcitonin (PCT) is found in thyroidal cells during non-pathologic states but Age , median (range) 65 (27-89) 71 (19-102) <0.01
released by multiple tissues in response to bacterial infections (1).
Underlying condition
• PCT has been used as a predictor of adverse outcomes, as a diagnostic marker for Malignancy
bacterial infections and as a guide for antibiotic management decisions (2-4). Solid organ 69 (67) - -
Hematologic 36 (34.9) - -
• A limited number of studies have explored its use and interpretation in cancer Both 2 (1.9) - -
patients (5,6). Transplant 8 (7.8) 18 (7.5) 1.00
SOT 1 (1.0) 18 (7.5) 0.03
• We assessed the feasibility of the new-generation PCT assay in cancer patients at
BMT 7 (6.8) 0 (0) <0.01
our University hospital in the New York City.
HIV 0 (0) 4 (1.7) 0.32
Cardiovascular 23 (22.3) 122 (51) <0.01
Diabetes 17 (16.5) 66 (27.6) 0.04
Chronic kidney disease 10 (9.7) 46 (19.2) 0.04
Materials and Methods Pulmonary (chronic) 25 (24.3) 61 (25.5) 0.91
Liver Disease 10 (9.7) 32 (13.4) 0.44
• All patient and microbiology data was retrieved from microbiology database and Major Surgery 18 (17.5) 42 (17.6) 1.00
computerized physician order system (CPOE) at NYU Langone Medical Center
between April 2012 and February 2013.
Immunosuppression
Chemotherapy 62 (60.2) 0 (0) -
• Patient data were evaluated retrospectively by review of electronic medical
Steroids* 15 (14.6) 16 (6.7) 0.03
records (EMS).
Other immunosuppresants** 1 (1) 19 (7.9) 0.02
• Clinical, microbiologic and radiographic responses were assessed according to TNF inhibitors 2 (1.9) 3 (1.3) 0.64 outliers are represented by circles and extremes by stars
established guidelines. Neutropenia (ANC<500) 13 (12.6) 7 (2.9) <0.01

• Standard definitions were used for sepsis, systemic inflammatory response *Prednisone ≥ 20 mg for 4 weeks or equivalent. **Tacrolimus, mycophenolate or cyclosporine.
syndrome (SIRS), severe sepsis and septic shock (7). SOT, solid-organ transplant; BMT, bone marrow transplant; ANC, absolute neutrophil count. Conclusions
• Chi-square and Mann Whitney U test were used for categorical and continuous • PCT appears promising in assessing cancer patients with Gram negative
variables, respectively. infections.
Table 2. Procalcitonin (PCT) values* in cancer and non-cancer patients by categories of infection
• PCT values may be modestly higher in cancer patients when compared with
patients with no known malignancy. The reason for this difference may in
part be related with perturbation in inflammatory response even in the
All cases Cancer patients Non-Cancer patients
absence of infection.
Results Category of infection N Median PCT (range) N Median PCT (range) N Median PCT (range) P value

All cases 342 0.43 (0.05-726.70) 103 0.65 (0.05-726.70) 239 0.32 (0.05-197) 0.04
• High PCT values were significantly more common in patients with infection-
related sepsis vs. SIRS.
Microbiologically proven infection 158 0.67 (0.05-197) 36 2.52 (0.05-172.73) 122 0.5 (0.05-197) <0.01
Among 342 adult patients age was 68 (19-102) years and 30.1% of the total were
undergoing treatment for cancer. Among patients without cancer, cardiovascular Gram positive 70 0.52 90.05-73.10) 20 2.02 (0.05-73.10) 50 0.35 (0.05-48.66) 0.08
disease (51 vs. 22.3%), diabetes (27.6 vs. 16.5%) and chronic kidney disease (19.2 vs.
Gram negative 102 0.81 (0.05-197) 19 4.22 (0.09-172.73) 83 0.59 (0.05-197) <0.01
9.7%) were significantly higher than patients with cancer (P<0.05; table 1). Patients in
critical care unit had an overall high PCT levels (0.82) compared with non-ICU patients Total bacteremia 38 1.33 (0.05-197) 10 3.92 (0.06-172.73) 28 0.97 (0.05-197) 0.37
(0.22; P <0.01). Table 2 shows that PCT levels were higher in patients with cancer
among those with microbiologically proven infections (P=0.04), especially Gram-
Bacteremia (no identified source)
Localized infections (without
19 2.01 (0.05-197) 5 3.63 (0.06-18.67) 14 1.56 (0.05-197) 0.96 References
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