title: The utility of proadrenomedullin and procalcitonin in comparison to C-reactive protein as predictors of sepsis and bloodstream infections in critically ill patients with cancer*.
abstract: OBJECTIVE
  Infections in critically ill patients continue to impose diagnostic and therapeutic challenges. We seek to investigate the utility of proadrenomedullin and procalcitonin as diagnostic and prognostic biomarkers in febrile critically ill patients with cancer and compare their performance with that of C-reactive protein.
  
  
  METHODS
  Single-center prospective cohort study.
  
  
  METHODS
  Tertiary care, academic, university hospital.
  
  
  METHODS
  One hundred fourteen critically ill patients with cancer with fever.
  
  
  METHODS
  None.
  
  
  RESULTS
  Blood samples were withdrawn on the day of fever onset and 4 to 7 days thereafter, and the serum proadrenomedullin, procalcitonin, and C-reactive protein levels were measured using the Kryptor technology afterward. Of the 114 adult patients, 27 had bloodstream infections, 36 had localized infections, and the remaining had no infections. The area under the receiver operating characteristic curve for bloodstream infection diagnosis was significantly greater for proadrenomedullin (0.70; 95% CI, 0.59-0.82) and procalcitonin (0.71; 95% CI, 0.60-0.83) compared with C-reactive protein (0.53; 95% CI, 0.39-0.66) (p = 0.021 and p = 0.003, respectively). Receiver operating characteristic analysis also showed that proadrenomedullin (p = 0.005) and procalcitonin (p = 0.009) each had a better performance than C-reactive protein in predicting patients' mortality within 2 months after their fever onset. Regarding patients' response to antimicrobial therapy, proadrenomedullin, procalcitonin, and C-reactive protein levels all significantly decreased from baseline to follow-up in responders (p ≤ 0.002), whereas only proadrenomedullin level significantly increased in nonresponders (p < 0.0001). In patients with documented infections, proadrenomedullin (0.81; 95% CI, 0.71-0.92) and procalcitonin (0.73; 95% CI, 0.60-0.85) each had a greater area under the curve compared with C-reactive protein (0.59; 95% CI, 0.45-0.73) as for as predicting response (p = 0.004 and p = 0.043, respectively). However, for all febrile patients, proadrenomedullin had a significantly greater area under the curve for predicting favorable response than procalcitonin (p < 0.0001).
  
  
  CONCLUSIONS
  In critically ill patients with cancer, proadrenomedullin and procalcitonin both have a promising role in predicting bloodstream infections in a manner more helpful than C-reactive protein. These two biomarkers were superior to C-reactive protein in the prognostic analysis of response to antimicrobial therapy for those patients with documented infections. However, proadrenomedullin was superior to procalcitonin in predicting response in all febrile patients and was unique in showing increased levels among nonresponders.
authors.affiliation: 1Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX. 2Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX. 3Medical University Department, Kantonsspital Aarau, Tellstrasse, Aarau, Switzerland.
authors.forename: Labib
authors.initials: L
authors.lastname: Debiane
authors.forename: Ray Y
authors.initials: RY
authors.lastname: Hachem
authors.forename: Iba
authors.initials: I
authors.lastname: Al Wohoush
authors.forename: William
authors.initials: W
authors.lastname: Shomali
authors.forename: Ramez R
authors.initials: RR
authors.lastname: Bahu
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Chaftari
authors.forename: Joseph
authors.initials: J
authors.lastname: Jabbour
authors.forename: Munirah
authors.initials: M
authors.lastname: Al Shuaibi
authors.forename: Alexander
authors.initials: A
authors.lastname: Hanania
authors.forename: S Egbert
authors.initials: SE
authors.lastname: Pravinkumar
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.forename: Issam
authors.initials: I
authors.lastname: Raad
mesh_terms: D000046:Academic Medical Centers; D053607:Adrenomedullin / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000097:blood / Q000453:epidemiology; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D018805:Sepsis / Q000097:blood* / Q000453:epidemiology
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide