Diagnostic value of procalcitonin serum levels in comparison with C-reactive protein in allogeneic stem cell transplantation.
OBJECTIVE
Infections represent the major complications following allogeneic stem cell transplantation (SCT). A promising marker for a more specific and early detection of bacterial or fungal infections is procalcitonin (PCT).


METHODS
Maximum values (m) and increase (Delta) of PCT and C-reactive protein (CRP) were prospectively analyzed during 214 clinical events in a cohort of 61 patients undergoing allogeneic SCT. Systemic reactions during bacterial or fungal infections were classified according to the ACCP/SCCM criteria.


RESULTS
mPCT and mCRP (normal <0.5 microg/L and <5 mg/L, respectively) levels were high during bacterial and fungal infections (median 2.3 microg/L and 188 mg/L), moderately elevated during fever of unknown origin (median 1.5 microg/L and 82 mg/L) and low during clinical events for which there was no evidence of bacterial or fungal infections (median 0.4 microg/L and 55 mg/L). The area under the receiver operator characteristic (ROC) curve was 0.70 for mPCT, 0.76 for mCRP, 0.76 for DeltaPCT and 0.83 for DeltaCRP. Cut-off concentrations for optimum prediction of bacterial or fungal infection were: mPCT > 1 microg/L, mCRP > 100 mg/L, DeltaPCT > 1 microg/L and DeltaCRP > 50 mg/L. An increase of PCT during a bacterial or fungal infection was usually detected 1 day after the onset of fever, while the rise of CRP occurred 1 day before. mPCT was strongly correlated with the severity of systemic reaction during infection (sepsis vs severe sepsis/septic shock: p=0.0002).


CONCLUSIONS
The diagnostic value of PCT was not superior to that of CRP in the detection of bacterial or fungal infections after allogeneic SCT. However, PCT assays may be useful in studies which compare the severity of infectious complications.
Hambach
Lothar
L
Department of Hematology and Oncology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
Eder
Matthias
M
Dammann
Elke
E
Schrauder
Andreas
A
Sykora
Karl-Walter
KW
Dieterich
Christian
C
Kirschner
Philip
P
Novotny
Jürgen
J
Ganser
Arnold
A
Hertenstein
Bernd
B
D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002352:Carrier Proteins / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006402:Hematologic Diseases / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014184:Transplantation, Homologous / Q000009:adverse effects
D015415:Biomarkers; C000606589:CALCA protein, human; D002352:Carrier Proteins; D011498:Protein Precursors; C020723:citrate-binding transport protein; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide