Evaluation of C-reactive protein and procalcitonin as a mortality indicator in febrile neutropenic patients

Authors : Hasan Öksüzoğlu, Duygu Mert, Gülşen İskender, Nagihan Ulu Demirci, Mustafa Ertek

Pages : 384-395

Doi:10.31362/patd.1552581

View : 56 | Download : 114

Publication Date : 2025-04-01

Article Type : Research Paper

Abstract :Purpose: Febrile neutropenia (FN) is a common side effect of chemotherapy in cancer patients, leading to complications, increased healthcare costs, and mortality. Microbiological agents can be identified in 30-50% of FN cases. Therefore, there is a need for specific, highly effective, and rapid markers to indicate infection. Various biomarkers are currently under investigation and in clinical use. This study aims to evaluate their effectiveness in the early detection of infection and mortality by comparing quantitative C-reactive protein (CRP) and procalcitonin levels at the onset of FN and during treatment. Material and methods: This study is a retrospective case-control study. It included 572 patients with febrile neutropenia (FN) who were followed up in the Hematology Clinic, Bone Marrow Transplantation Unit, and Medical Oncology Clinic between September 3, 2018, and May 25, 2022. A total of 748 FN episodes were recorded in these patients. Data were retrieved from the hospital information management system and documented using a pre-prepared form. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) 26.0 software. Results: Of the febrile neutropenia (FN) patients included in the study, 118 experienced mortality, whereas 630 survived. The mean age was 51.6 years in the mortality group and 50.5 years in the non-mortality group. Females constituted 47.9% of the cohort, while males accounted for 52.1%. Hematological malignancies were present in 67.2% of all patients. Bacteremia was identified in 36.5% of FN episodes. Although E. coli was the most frequently isolated microorganism, P. aeruginosa and A. baumannii were more commonly detected in patients who succumbed to the illness. Elevated C-reactive protein (CRP) and procalcitonin levels within the first five days of treatment were significantly associated with both mortality and the presence of bacteremia. Neither leukocyte count nor absolute neutrophil count at the time of diagnosis showed a significant association with mortality. However, prolonged duration of neutropenia, bloodstream infections, catheter-related bloodstream infections, and the presence of pneumonia emerged as significant risk factors for mortality. Conclusion: CRP and procalcitonin levels were observed to have both prognostic and diagnostic value. Additionally, resistant Gram-negative bacterial growth was more frequently detected in the blood cultures of patients who did not survive. Further studies are needed to develop new treatment algorithms.
Keywords : Febril nötropeni, C-reaktif protein, prokalsitonin, mortalite