Non-infectious causes of elevated procalcitonin and C-reactive protein serum levels in pediatric patients with hematologic and oncologic disorders.
BACKGROUND
Procalcitonin (PCT) is considered a sensitive and specific diagnostic and prognostic marker of systemic bacterial infection, but its value is questionable in certain clinical conditions, particularly in hemato-oncological patients.


METHODS
We analyzed PCT and C-reactive protein (CRP) levels in 56 patients of a pediatric hematology-oncology unit during 110 consecutive non-infectious febrile episodes related to administration of T-cell antibodies (group A; n = 22), alemtuzumab (monoclonal CD52 antibody, CAMPATH-1H/group B; n = 8), interleukin-2 (IL-2/group C; n = 41), prophylactic donor granulocyte transfusions (group D; n = 9), or to acute graft-versus-host disease (aGvHD/group E; n = 10) and compared the results with 20 episodes of Gram-negative sepsis (group F).


RESULTS
In the majority of the non-infectious episodes PCT and CRP increased to serum levels statistically indistinguishable from Gram-negative sepsis. Median peak levels of PCT (normal < 0.5 ng/ml)/CRP (normal < 8 mg/l) for groups A-F were 4.34/59.0 (A), 10.14/93.5 (B), 1.11/175.0 (C), 1.43/164 (D), 0.96/34.0 (E), and 8.14 ng/ml /126.0 mg/l (F). Highest single levels were observed in groups A and F.


CONCLUSIONS
PCT and CRP are of limited value as diagnostic markers of sepsis during T-cell-directed immunomodulatory treatment, granulocyte support, or acute GvHD.
Dornbusch
Hans Jürgen
HJ
Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 30, Graz, Austria. hansjuergen.dornbusch@meduni-graz.at
Strenger
Volker
V
Sovinz
Petra
P
Lackner
Herwig
H
Schwinger
Wolfgang
W
Kerbl
Reinhold
R
Urban
Christian
C
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood; D006402:Hematologic Diseases / Q000097:blood / Q000175:diagnosis; D019337:Hematologic Neoplasms / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007376:Interleukin-2 / Q000097:blood; D008297:Male; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*
D015415:Biomarkers; D014408:Biomarkers, Tumor; C000606589:CALCA protein, human; D007376:Interleukin-2; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide