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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

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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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Funding

The study was supported by Taiwan National Science Council Grant, NSC 100_2341_B_002_138_MY3 and, National Taiwan University Hospital Yunlin Branch Research Grant, NTUHYL102S008.

Conflict of interest

None declared

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Chun-Wei Wu, Chun-Kuei Chen & Shiau-Ling Huang

  2. Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Shy-Shin Chang

  3. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Shy-Shin Chang

  4. Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Jiunn-Yih Wu & Shou-Chien Hsu

  5. Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, 100, Taiwan

    Meng-tse Gabriel Lee & Chien-Chang Lee

  6. Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan

    Chien-Chang Lee

  7. Department of Epidemiology, Harvard School of Public Health, Boston, USA

    Chien-Chang Lee

Authors
  1. Chun-Wei Wu
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  2. Jiunn-Yih Wu
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  6. Meng-tse Gabriel Lee
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  7. Shy-Shin Chang
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  8. Chien-Chang Lee
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Correspondence to Shy-Shin Chang or Chien-Chang Lee.

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Wu, CW., Wu, JY., Chen, CK. et al. 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. Support Care Cancer 23, 2863–2872 (2015). https://doi.org/10.1007/s00520-015-2650-8

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  • DOI: https://doi.org/10.1007/s00520-015-2650-8

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