title: Elevated procalcitonin predicts Gram-negative sepsis in haematological patients with febrile neutropenia.
abstract: OBJECTIVE
  To compare semi-quantitative procalcitonin with C-reactive protein in predicting bacteraemia in haematological patients with neutropenic fever.
  
  
  METHODS
  A total of 77 patients treated with intensive chemotherapy for haematological malignancy at Kuopio University Hospital were candidates for study entry. Eleven of these patients did not fulfil the criteria for neutropenic fever, and 66 patients were finally included. Nineteen patients had acute myeloid leukaemia and 47 had received high-dose chemotherapy supported by autologous stem cell transplant. Ninety neutropenic fever episodes in these 66 patients fulfilled the study entry criteria, with microbiological cultures, procalcitonin and C-reactive protein measurements available. Serum procalcitonin and C-reactive protein were analyzed at the onset of each neutropenic fever episode on day 0, and then daily from days 1 to 4.
  
  
  RESULTS
  Bacteraemia was observed in 21 episodes (23%) and the criteria for severe sepsis were fulfilled in 13 episodes (14%). Half of the bacteraemic episodes were caused by Gram-negative bacteria. The kinetics of procalcitonin and C-reactive protein were similar, with increasing levels for 2 to 4 days after the onset of fever. The procalcitonin level on days 1, 2, 3 and 4 was associated with bacteraemia and Gram-negative bacteraemia, but not with the development of severe sepsis. On day 1, a procalcitonin level above 0.5 ng/ml had a sensitivity of 57% and 70% and specificity of 81% and 77% to predict bacteraemia and Gram-negative bacteraemia, respectively.
  
  
  CONCLUSIONS
  An elevated level of procalcitonin within 24 h after the onset of neutropenic fever predicts bacteraemia and Gram-negative bacteraemia in haematological patients.
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland. irma.koivula@kuh.fi
authors.forename: Irma
authors.initials: I
authors.lastname: Koivula
authors.forename: Sari
authors.initials: S
authors.lastname: Hämäläinen
authors.forename: Esa
authors.initials: E
authors.lastname: Jantunen
authors.forename: Kari
authors.initials: K
authors.lastname: Pulkki
authors.forename: Taru
authors.initials: T
authors.lastname: Kuittinen
authors.forename: Tapio
authors.initials: T
authors.lastname: Nousiainen
authors.forename: Auni
authors.initials: A
authors.lastname: Juutilainen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D005335:Fever of Unknown Origin / Q000150:complications / Q000175:diagnosis*; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000175:diagnosis*; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide