The role of procalcitonin in identifying high‐risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score

Abstract Background The Multinational Association for Supportive Care in Cancer (MASCC) risk index has been utilized to determine the risk for poor clinical outcomes in patients with febrile neutropenia (FN) in an emergency center (EC). However, this index comprises subjective elements and elaborate...

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Autores principales:	Patrick Chaftari, Anne‐Marie Chaftari, Ray Hachem, Sai‐Ching J. Yeung, Hiba Dagher, Ying Jiang, Alexandre E. Malek, Natalie Dailey Garnes, Victor E. Mulanovich, Issam Raad
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	cancer patients febrile neutropenia immunocompromised lactate neutropenia procalcitonin Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/c6c0b87b0d71463092833a8d76c5eb39
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spelling	oai:doaj.org-article:c6c0b87b0d71463092833a8d76c5eb392021-12-01T04:49:15ZThe role of procalcitonin in identifying high‐risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score2045-763410.1002/cam4.4355https://doaj.org/article/c6c0b87b0d71463092833a8d76c5eb392021-12-01T00:00:00Zhttps://doi.org/10.1002/cam4.4355https://doaj.org/toc/2045-7634Abstract Background The Multinational Association for Supportive Care in Cancer (MASCC) risk index has been utilized to determine the risk for poor clinical outcomes in patients with febrile neutropenia (FN) in an emergency center (EC). However, this index comprises subjective elements and elaborated metrics limiting its use in ECs. We sought to determine whether procalcitonin (PCT) level (biomarker of bacterial infection) with or without lactate level (marker of inadequate tissue perfusion) offers a potential alternative to MASSC score in predicting the outcomes of patients with FN presenting to an EC. Methods We retrospectively identified 550 cancer patients with FN who presented to our EC between April 2018, and April 2019, and had serum PCT and lactate levels measured. Results Compared with patients with PCT levels <0.25 ng/ml, those with levels ≥0.25 ng/ml had a significantly higher 14‐day mortality rate (5.2% vs. 0.7%; p = 0.002), a higher bloodstream infection (BSI) rate, and a longer hospital length of stay (LOS). Logistic regression analysis showed that patients with PCT levels ≥0.25 ng/ml and lactate levels >2.2 mmol/L were more likely to be admitted and have an LOS >7 days, BSI, and 14‐day mortality than patients with lower levels. PCT level was a significantly better predictor of BSI than MASSC score (p = 0.003) or lactate level (p < 0.0001). Conclusions Procalcitonin level is superior to MASCC index in predicting BSI. The combination of PCT and lactate levels is a good predictor of BSI, hospital admission, and 14‐day mortality and could be useful in identifying high‐risk FN patients who require hospital admission.Patrick ChaftariAnne‐Marie ChaftariRay HachemSai‐Ching J. YeungHiba DagherYing JiangAlexandre E. MalekNatalie Dailey GarnesVictor E. MulanovichIssam RaadWileyarticlecancer patientsfebrile neutropeniaimmunocompromisedlactateneutropeniaprocalcitoninNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancer Medicine, Vol 10, Iss 23, Pp 8475-8482 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cancer patients febrile neutropenia immunocompromised lactate neutropenia procalcitonin Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	cancer patients febrile neutropenia immunocompromised lactate neutropenia procalcitonin Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Patrick Chaftari Anne‐Marie Chaftari Ray Hachem Sai‐Ching J. Yeung Hiba Dagher Ying Jiang Alexandre E. Malek Natalie Dailey Garnes Victor E. Mulanovich Issam Raad The role of procalcitonin in identifying high‐risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score
description	Abstract Background The Multinational Association for Supportive Care in Cancer (MASCC) risk index has been utilized to determine the risk for poor clinical outcomes in patients with febrile neutropenia (FN) in an emergency center (EC). However, this index comprises subjective elements and elaborated metrics limiting its use in ECs. We sought to determine whether procalcitonin (PCT) level (biomarker of bacterial infection) with or without lactate level (marker of inadequate tissue perfusion) offers a potential alternative to MASSC score in predicting the outcomes of patients with FN presenting to an EC. Methods We retrospectively identified 550 cancer patients with FN who presented to our EC between April 2018, and April 2019, and had serum PCT and lactate levels measured. Results Compared with patients with PCT levels <0.25 ng/ml, those with levels ≥0.25 ng/ml had a significantly higher 14‐day mortality rate (5.2% vs. 0.7%; p = 0.002), a higher bloodstream infection (BSI) rate, and a longer hospital length of stay (LOS). Logistic regression analysis showed that patients with PCT levels ≥0.25 ng/ml and lactate levels >2.2 mmol/L were more likely to be admitted and have an LOS >7 days, BSI, and 14‐day mortality than patients with lower levels. PCT level was a significantly better predictor of BSI than MASSC score (p = 0.003) or lactate level (p < 0.0001). Conclusions Procalcitonin level is superior to MASCC index in predicting BSI. The combination of PCT and lactate levels is a good predictor of BSI, hospital admission, and 14‐day mortality and could be useful in identifying high‐risk FN patients who require hospital admission.
format	article
author	Patrick Chaftari Anne‐Marie Chaftari Ray Hachem Sai‐Ching J. Yeung Hiba Dagher Ying Jiang Alexandre E. Malek Natalie Dailey Garnes Victor E. Mulanovich Issam Raad
author_facet	Patrick Chaftari Anne‐Marie Chaftari Ray Hachem Sai‐Ching J. Yeung Hiba Dagher Ying Jiang Alexandre E. Malek Natalie Dailey Garnes Victor E. Mulanovich Issam Raad
author_sort	Patrick Chaftari
title	The role of procalcitonin in identifying high‐risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score
title_short	The role of procalcitonin in identifying high‐risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score
title_full	The role of procalcitonin in identifying high‐risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score
title_fullStr	The role of procalcitonin in identifying high‐risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score
title_full_unstemmed	The role of procalcitonin in identifying high‐risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score
title_sort	role of procalcitonin in identifying high‐risk cancer patients with febrile neutropenia: a useful alternative to the multinational association for supportive care in cancer score
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/c6c0b87b0d71463092833a8d76c5eb39
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The role of procalcitonin in identifying high‐risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score

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