The Clinical Application Of Procalcitonin In Febrile Non-Neutropenia Cancer Patients

Objective:Through the study of the relationship between serum procalcitonin (PCT) and fever in Non-neutropenic cancer patients (NCCPs), analysis whether the PCT can be used to determine the specific reason for the fever of non-neutropenia tumor patients. To explore the application value of the PCT level in identification of gram-negative bacteria, gram-positive bacteria which caused by infection of the bloodstream and PCT clinical significance in guidance of antibiotic therapy in NNCPs.Methods:(1) Identified in the experimental standard. (2) We collected 100 cases of NNCPs in our hospital, According to the clinical data and the results of microbiological culture will be divided into group A (blood infection group) including 24 cases, Group B (localized bacterial infection) 42 cases included, C group:25 with no documented infection, and D group:9 with tumor-related fever.(3) According to a 2001 Washington sepsis diagnosis standard, the subjects were divided into sepsis group with 27 cases,30 cases in SIRS group, no infection and no SIRS group of 28 cases.(4) According to the results of microbial culture, the subjects were divided into groups of 37 cases of gram negative bacteria, gram positive bacteria group with 29 cases.(5) According to the cancer patients with metastasis, the subjects were divided into metastasis group 55 cases,37 cases of non tumor metastasis group.(6) Subjects using antibiotics, blood stream infection were 24 cases, local infection group with 30 cases,3 cases of tumor associated fever. (7) Respectively in fever within 24 hours prior to antibiotic therapy according to standard operating rules for blood blood culture local foci of infection bacterial culture and using the Roche E601 electrochemisty luminescence autromatic immune analyzer to detect the PCT levels and in antibiotic use 96 hours after serum was collected again monitory of PCT level. Capacity analysis of serum PCT in patients with NNCPs in the identification of the cause of fever in statistical.Results:(1) Patients in A group had significantly higher PCT lever than did those in B group (median PCT1.68ng/ml VS 0.33ng/ml; P=0.0023) and in C group(median PCT 1.68ng/ml VS 0.29ng/ml; P=0.0002) and in D group (median PCT1.68ng/ml VS 0.53ng/ml; P=0.031). (2) Based on the results of ROC curve, the optimal PCT cutoff level to diagnosis bloodstream infection was 0.52ng/ml,the area under the ROC curve (AUC) was 0.765(95%confidence interval,0.67-0.86), When PCT cut-off is 0.52ng/ml, the sensitivity was 79.2%, specificity was 65.8%. (3) Sepsis group and SRIS group had significantly higher PCT lever than without infection and without sepsis group, P=0.003, P=0.015, The three group the median values were 0.65ng/ml,0.41 ng/ml,0.22 ng/ml, while the PCT lever in sepsis group and SIRS group had no significantly difference P=0.46。(4) When the PCT is 0.5 ng/ml as the threshold in the diagnosis of sepsis, the positive rates in A group, B group, C group,were 100%, 77.8%,66.7%.(5) Metastasis group the median value of PCT is 0.48ng/ml,higher than that in non tumor metastasis group, PCT is 0.27ng/ml P<0.05,The difference was statistically significant. (6) In the A group, the median of PCT was 2.51ng/ml in gram negative bacteria and the median of PCT was 0.76 ng/ml in gram positive bacteria, P=0.328, the difference was statistically significant. In the B group, the median of PCT was 0.38 ng/ml in gram negative bacteria and the median of PCT was 0.30 ng/ml in gram positive bacteria P=0.328.the difference had no significantly difference. (7) According to the ROC curve, the best values of PCT to distinction bloodstream infection of gram negative bacteria> gram positive bacteria in NNCPs was 1.11 ng/ml, The area under ROC curve was 0.879, the sensitivity was 89.3%, specificity was 70.1%. (8) After 96 hours, Patients with BSI and with documented localized infection had significantly decrease of PCT lever(0.86ng/ml vs 1.68ng/ml;0.12ng/ml vs 0.33ng/ml) (P=0.004, P<0.001), while Patients with tumor-related fever the PCT level did not decrease. (P=0.56).Conclusion:(1)PCT levels can be used to determine the specific reasons the fever of NNCPs.(2) PCT levels may be an important marker of antibiotic use in NNCPs. (3) Serum PCT has diagnostic value in differentiating Gram-negative and Gram-positive bacteria bloodstream infections. The risk of Gram-negative bacteria bloodstream infection is increased when PCT is>1.11ng/ml.