A Prospective Observational Study of the Prognostic Role of Procalcitonin Compared with High Sensitivity C Reactive Protein in Patients ≥ 15Years of Age with Acute Lymphoblastic Leukemia/Lymphoma with Febrile Neutropenia

Purpose

Our objective was to identify whether procalcitonin (PCT) and C Reactive protein (CRP) are useful biomarkers for patients with acute lymphoblastic leukemia/lymphoma (ALL) and febrile neutropenia (FN). We included patients ≥ 15 years of age as existing literature on them is limited.

Methods

In this prospective observational study, high sensitivity CRP (hsCRP) and PCT were estimated for all patients at baseline, 48 hours, and 96 hours after administration of broad-spectrum empirical antibiotics. The level of these parameters was then correlated with bacteremia, requirement of antibiotic augmentation, septic shock, ICU admission, prolonged hospitalisation, and death.

Results

We analysed 33 episodes of FN. Bacteremia was seen in 12% and augmentation of antibiotics was done in 30% of the episodes. Two patients had septic shock; no death or ICU admission was observed. Prolonged hospitalisation was required in 36% of the episodes. The hsCRP and PCT peaked at 48 hours, and the PCT level was significantly higher in the group with bacteremia, antibiotic augmentation, and prolonged hospitalisation. The area under the curve (AUC) for PCT (at 48 hours) was greater than hsCRP for antibiotic augmentation and prolonged hospitalisation.

Conclusion

As a supplement to clinical decision making, serial monitoring of PCT should be done. Levels of PCT at 48 hours of starting antibiotic therapy (≥ 0.82ng/ml) can be used for early augmentation of antibiotic therapy to prevent complications of FN in patient undergoing treatment for ALL.