Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Cancer Med. 2021 Dec;10(23):8475-8482. doi: 10.1002/cam4.4355. Epub 2021 Nov 1.
The Multinational Association for Supportive Care in Cancer (MASCC) risk index has been utilized to determine the risk for poor clinical outcomes in patients with febrile neutropenia (FN) in an emergency center (EC). However, this index comprises subjective elements and elaborated metrics limiting its use in ECs. We sought to determine whether procalcitonin (PCT) level (biomarker of bacterial infection) with or without lactate level (marker of inadequate tissue perfusion) offers a potential alternative to MASSC score in predicting the outcomes of patients with FN presenting to an EC.
We retrospectively identified 550 cancer patients with FN who presented to our EC between April 2018, and April 2019, and had serum PCT and lactate levels measured.
Compared with patients with PCT levels <0.25 ng/ml, those with levels ≥0.25 ng/ml had a significantly higher 14-day mortality rate (5.2% vs. 0.7%; p = 0.002), a higher bloodstream infection (BSI) rate, and a longer hospital length of stay (LOS). Logistic regression analysis showed that patients with PCT levels ≥0.25 ng/ml and lactate levels >2.2 mmol/L were more likely to be admitted and have an LOS >7 days, BSI, and 14-day mortality than patients with lower levels. PCT level was a significantly better predictor of BSI than MASSC score (p = 0.003) or lactate level (p < 0.0001).
Procalcitonin level is superior to MASCC index in predicting BSI. The combination of PCT and lactate levels is a good predictor of BSI, hospital admission, and 14-day mortality and could be useful in identifying high-risk FN patients who require hospital admission.
多国癌症支持治疗协会（MASCC）风险指数已被用于确定急诊中心（EC）中性粒细胞减少症发热（FN）患者发生不良临床结局的风险。然而，该指数包含主观因素和详细指标，限制了其在 EC 中的应用。我们旨在确定降钙素原（PCT）水平（细菌感染的生物标志物）和/或乳酸水平（组织灌注不足的标志物）是否可以替代 MASCC 评分，预测 FN 患者在 EC 就诊的结局。
我们回顾性地确定了 2018 年 4 月至 2019 年 4 月期间在我们 EC 就诊的 550 例 FN 癌症患者，这些患者的血清 PCT 和乳酸水平均有测量。
与 PCT 水平 <0.25ng/ml 的患者相比，PCT 水平≥0.25ng/ml 的患者 14 天死亡率显著更高（5.2% vs. 0.7%；p=0.002）、血流感染（BSI）发生率更高、住院时间（LOS）更长。Logistic 回归分析显示，PCT 水平≥0.25ng/ml 和乳酸水平 >2.2mmol/L 的患者更有可能住院、LOS>7 天、BSI 以及 14 天死亡率，比水平较低的患者更高。PCT 水平是预测 BSI 的指标，优于 MASCC 评分（p=0.003）或乳酸水平（p<0.0001）。
PCT 水平优于 MASCC 指数，可预测 BSI。PCT 和乳酸水平的组合是预测 BSI、住院、14 天死亡率的良好指标，可用于识别需要住院的 FN 高危患者。
