Procalcitonin as early predictor of bacteremia in critically ill neutropenic patients

Background: Procalcitonin (PCT) could predict the presence of bacteremia in critically ill patients with febrile neutropenia. The objective was to determine the predictive value of PCT in the diagnosis of bacteremia and its ability to differentiate between gram-negative and gram-positive organisms. Methods: Retrospective cohort study conducted at the Oncology Hospital "Solon Espinosa Ayala,"Quito-Ecuador, which included patients who were admitted with febrile neutropenia to intensive therapy. PCT values were evaluated at admission together with blood culture samples, from 2010 to 2016. Results: The association between PCT levels and the diagnosis of bacteremia was investigated in 117 patients. PCT demonstrated bacteremia discrimination with a point of cut of 15.5 ng/ml and an area under the curve (AUC) of 0.76. The concentration of PCT in patients with bacteremia by gram-negative germs was higher compared with patients with bacteremias by gram-positive germs, 26 vs. 71 ng/ml (p = 0.001). Values > 26.8 ng/ml predict bacteremia by Gram-negative bacilli (AUC: 0.81). Conclusions: A cut-off value of PCT > 15.5 ng/ml is a predictor of bacteremia (AUC: 0.76) and values > 26.8 ng/ml predict bacteremia by gram-negative bacilli (AUC: 0.81).