Causes of fever and value of C-reactive protein and procalcitonin in differentiating infections from paraneoplastic fever.
OBJECTIVE
The aims of our retrospective study were to study first the causes of 245 febrile episodes in cancer patients and then the value of procalcitonin (PCT) and C-reactive protein (CRP) in differentiating infections from paraneoplastic fever.


METHODS
The causes of fever were studied in 245 consecutive cases observed between January and December 2002, and PCT and CRP diagnostic value in 155 cases (114 infections and 41 paraneoplastic fever).


RESULTS
The two main causes of fever were infection (121 cases) and paraneoplastic fever (43 cases); 77 infections were microbiologically documented. Cocci gram positive caused 41 out of 77 documented infections. Paraneoplastic fever was more frequent in metastatic disease ( p=6.10(-6)). CRP and PCT serum levels at admission did not differ significantly in the infection group and paraneoplastic fever group (respectively p=0.39 and p=0.14 with Mann-Whitney test). The PCT and CRP levels had poor prognostic value in infection (respectively 0.04 and 0.0003 with Mann-Whitney test).


CONCLUSIONS
Causes of fever are very numerous in cancer patients (more than 75 different causes in this study). Bacterial infection is the most frequent cause. PCT and CRP failed to discriminate infection, but both had pejorative prognostic value in infected patients.
Penel
Nicolas
N
Département de cancérologie générale, Centre Oscar Lambret, 3 rue F Combemale, 59020 Lille, France. n-penel@o-lambret.fr
Fournier
Charles
C
Clisant
Stéphanie
S
N'Guyen
Michèle
M
D015415:Biomarkers / Q000032:analysis*; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D007239:Infections / Q000150:complications / Q000175:diagnosis*; D008297:Male; D009369:Neoplasms / Q000150:complications; D010257:Paraneoplastic Syndromes / Q000175:diagnosis*; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide