Does procalcitonin, C-reactive protein, or interleukin-6 test have a role in the diagnosis of severe infection in patients with febrile neutropenia? A systematic review and meta-analysis

Chun Wei Wu, Jiunn Yih Wu, Chun Kuei Chen, Shiau Ling Huang, Shou Chien Hsu, Meng tse Gabriel Lee, Shy Shin Chang, Chien Chang Lee

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Purpose: The study aims to determine the usefulness of procalcitonin (PCT) and other blood markers for identification of bacterial infection among patients with febrile neutropenia (FN). Methods: The Medline, EMBASE, and Cochrane databases were searched for articles from 1966 to December 2012. We performed a search to identify articles that examined the diagnostic accuracy of PCT in patients with FN. Statistical analyses (fixed- or random-effect models) were conducted to summarize and calculate the sensitivity, specificity, likelihood ratios, and 95 % confidence intervals (CIs). Results: Twenty-seven studies were included (1960 febrile episodes) for PCT analysis, 13 (1712 febrile episodes) for C-reactive protein (CRP) analysis, and five (314 febrile episodes) for interleukin (IL)-6 analysis. Increased PCT levels (odds ratio [OR] 11.5; 95 % CI 7.6 to 17.3), raised CRP levels (3.3; 2.7 to 4.2), and raised IL-6 levels (10.0; 5.5 to 18.0) were significantly associated with bacterial infection. Overall positive likelihood ratio was 5.49 (4.04–7.45) for PCT, 1.82 (1.42–2.33) for CRP, and 3.68 (2.41–5.60) for IL-6. Overall negative likelihood ratio was 0.40 (0.31–0.51) for PCT, 0.40 (0.26–0.61) for CRP, and 0.33 (0.23–0.46) for IL-6. Conclusions: Of the three potentially useful markers, PCT had the best positive likelihood ratio and can be used to confirm the diagnosis of bacterial infections in patients with FN. Due to unacceptably high negative likelihood ratio, medical decision for stopping antibiotics based on PCT alone in this high-risk population may not be possible.

Original languageEnglish
Pages (from-to)2863-2872
Number of pages10
JournalSupportive Care in Cancer
Volume23
Issue number10
DOIs
Publication statusPublished - Oct 31 2015
Externally publishedYes

Fingerprint

Febrile Neutropenia
Calcitonin
C-Reactive Protein
Meta-Analysis
Interleukin-6
Infection
Bacterial Infections
Fever
Confidence Intervals
Odds Ratio
Databases
Anti-Bacterial Agents
Sensitivity and Specificity

Keywords

  • Neutropenic fever
  • Procalcitonin
  • Sepsis
  • Serious bacterial infection

ASJC Scopus subject areas

  • Oncology

Cite this

Does procalcitonin, C-reactive protein, or interleukin-6 test have a role in the diagnosis of severe infection in patients with febrile neutropenia? A systematic review and meta-analysis. / Wu, Chun Wei; Wu, Jiunn Yih; Chen, Chun Kuei; Huang, Shiau Ling; Hsu, Shou Chien; Lee, Meng tse Gabriel; Chang, Shy Shin; Lee, Chien Chang.

In: Supportive Care in Cancer, Vol. 23, No. 10, 31.10.2015, p. 2863-2872.

Research output: Contribution to journalArticle

Wu, Chun Wei ; Wu, Jiunn Yih ; Chen, Chun Kuei ; Huang, Shiau Ling ; Hsu, Shou Chien ; Lee, Meng tse Gabriel ; Chang, Shy Shin ; Lee, Chien Chang. / Does procalcitonin, C-reactive protein, or interleukin-6 test have a role in the diagnosis of severe infection in patients with febrile neutropenia? A systematic review and meta-analysis. In: Supportive Care in Cancer. 2015 ; Vol. 23, No. 10. pp. 2863-2872.
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abstract = "Purpose: The study aims to determine the usefulness of procalcitonin (PCT) and other blood markers for identification of bacterial infection among patients with febrile neutropenia (FN). Methods: The Medline, EMBASE, and Cochrane databases were searched for articles from 1966 to December 2012. We performed a search to identify articles that examined the diagnostic accuracy of PCT in patients with FN. Statistical analyses (fixed- or random-effect models) were conducted to summarize and calculate the sensitivity, specificity, likelihood ratios, and 95 {\%} confidence intervals (CIs). Results: Twenty-seven studies were included (1960 febrile episodes) for PCT analysis, 13 (1712 febrile episodes) for C-reactive protein (CRP) analysis, and five (314 febrile episodes) for interleukin (IL)-6 analysis. Increased PCT levels (odds ratio [OR] 11.5; 95 {\%} CI 7.6 to 17.3), raised CRP levels (3.3; 2.7 to 4.2), and raised IL-6 levels (10.0; 5.5 to 18.0) were significantly associated with bacterial infection. Overall positive likelihood ratio was 5.49 (4.04–7.45) for PCT, 1.82 (1.42–2.33) for CRP, and 3.68 (2.41–5.60) for IL-6. Overall negative likelihood ratio was 0.40 (0.31–0.51) for PCT, 0.40 (0.26–0.61) for CRP, and 0.33 (0.23–0.46) for IL-6. Conclusions: Of the three potentially useful markers, PCT had the best positive likelihood ratio and can be used to confirm the diagnosis of bacterial infections in patients with FN. Due to unacceptably high negative likelihood ratio, medical decision for stopping antibiotics based on PCT alone in this high-risk population may not be possible.",
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AU - Wu, Chun Wei

AU - Wu, Jiunn Yih

AU - Chen, Chun Kuei

AU - Huang, Shiau Ling

AU - Hsu, Shou Chien

AU - Lee, Meng tse Gabriel

AU - Chang, Shy Shin

AU - Lee, Chien Chang

PY - 2015/10/31

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N2 - Purpose: The study aims to determine the usefulness of procalcitonin (PCT) and other blood markers for identification of bacterial infection among patients with febrile neutropenia (FN). Methods: The Medline, EMBASE, and Cochrane databases were searched for articles from 1966 to December 2012. We performed a search to identify articles that examined the diagnostic accuracy of PCT in patients with FN. Statistical analyses (fixed- or random-effect models) were conducted to summarize and calculate the sensitivity, specificity, likelihood ratios, and 95 % confidence intervals (CIs). Results: Twenty-seven studies were included (1960 febrile episodes) for PCT analysis, 13 (1712 febrile episodes) for C-reactive protein (CRP) analysis, and five (314 febrile episodes) for interleukin (IL)-6 analysis. Increased PCT levels (odds ratio [OR] 11.5; 95 % CI 7.6 to 17.3), raised CRP levels (3.3; 2.7 to 4.2), and raised IL-6 levels (10.0; 5.5 to 18.0) were significantly associated with bacterial infection. Overall positive likelihood ratio was 5.49 (4.04–7.45) for PCT, 1.82 (1.42–2.33) for CRP, and 3.68 (2.41–5.60) for IL-6. Overall negative likelihood ratio was 0.40 (0.31–0.51) for PCT, 0.40 (0.26–0.61) for CRP, and 0.33 (0.23–0.46) for IL-6. Conclusions: Of the three potentially useful markers, PCT had the best positive likelihood ratio and can be used to confirm the diagnosis of bacterial infections in patients with FN. Due to unacceptably high negative likelihood ratio, medical decision for stopping antibiotics based on PCT alone in this high-risk population may not be possible.

AB - Purpose: The study aims to determine the usefulness of procalcitonin (PCT) and other blood markers for identification of bacterial infection among patients with febrile neutropenia (FN). Methods: The Medline, EMBASE, and Cochrane databases were searched for articles from 1966 to December 2012. We performed a search to identify articles that examined the diagnostic accuracy of PCT in patients with FN. Statistical analyses (fixed- or random-effect models) were conducted to summarize and calculate the sensitivity, specificity, likelihood ratios, and 95 % confidence intervals (CIs). Results: Twenty-seven studies were included (1960 febrile episodes) for PCT analysis, 13 (1712 febrile episodes) for C-reactive protein (CRP) analysis, and five (314 febrile episodes) for interleukin (IL)-6 analysis. Increased PCT levels (odds ratio [OR] 11.5; 95 % CI 7.6 to 17.3), raised CRP levels (3.3; 2.7 to 4.2), and raised IL-6 levels (10.0; 5.5 to 18.0) were significantly associated with bacterial infection. Overall positive likelihood ratio was 5.49 (4.04–7.45) for PCT, 1.82 (1.42–2.33) for CRP, and 3.68 (2.41–5.60) for IL-6. Overall negative likelihood ratio was 0.40 (0.31–0.51) for PCT, 0.40 (0.26–0.61) for CRP, and 0.33 (0.23–0.46) for IL-6. Conclusions: Of the three potentially useful markers, PCT had the best positive likelihood ratio and can be used to confirm the diagnosis of bacterial infections in patients with FN. Due to unacceptably high negative likelihood ratio, medical decision for stopping antibiotics based on PCT alone in this high-risk population may not be possible.

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KW - Sepsis

KW - Serious bacterial infection

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