Diagnostic Value Of PCT And CRP In Adult Patients With Malignant Hematologic Tumor With Fever

Objective:To investigate the diagnostic value of serum procalcitonin(PCT)and c-reactive protein(CRP)levels in the fever of adult patients with malignant hematologic tumors.Method:Serum levels of PCT and CRP were measured in 83 patients(174 times)with fever of adult patients with malignant hematologic tumors and 55 patients with no fever of adult patients with malignant hematologic tumors.According to the results of clinical features,microbiology and imaging examination,they were divided into(1)infective fever group(131 times),including ?microbiologically documented infection,MDI(69 times)and clinically documented infection,?CDI(62 times).The MDI can be divided into microbiologically documented infection with bacteremia,MDIB(40 times)and microbiologically documented infection without bacteremia,MDInB(29 times);(2)fever of unexplained origin group,FUO(43 times)and(3)no fever group(55 times),compare the difference of PCT and CRP between different groups,as well as the relationship between PCT and CRP level and disease type,degree of fever and neutrophile granulocyte level.Blood culture-positive patients(MDIB)were then divided into gram negative bacteria(G-)group and gram positive bacteria(G+)group,PCT and CRP levels between the two groups were compared,then the diagnostic efficacy of PCT and CRP in MDIB was evaluated by subject operating characteristic curve(ROC).Result:(1)PCT and CRP lever of patients with infectious fever and fever with unknown cause was significantly higher than that of patients without fever[0.36(0.17-2.17)ng/ml and 0.15(0.09-0.42)ng/ml vs 0.04(0.04-0.04)ng/ml?75.18(38.04-127.13)mg/L and 57.70(30.85-94.50)mg/L vs 2.06(0.77-7.2)mg/L],and the difference was statistically significant(P<0.05).The difference in PCT lever between the infectious fever group and the fever group with unknown cause was statistically significant(P=0.012<0.05),while the difference in CRP lever was not statistically significant(P>0.05).(2)Among the patients with fever caused by various etiology,the PCT level of MDIB group was significantly higher than that of MDInB,CDI and FUO group(P<0.05),while the PCT difference between MDInB,CDI and FUO groups was not statistically significant(P>0.05).CRP level in CDI group was significantly higher than that in MDInB group and FUO group(P<0.05),while the difference between other groups was not statistically significant(P>0.05).(3)Between different degrees of fever,the PCT level of patients in the high fever group was significantly higher than that in the moderate fever group,and the difference was statistically significant(Z =-3.96,P<0.001),while there was no statistically significant difference in CRP level between the two groups(P>0.05).(4)In patients with malignant hematologic tumor with fever,there was no statistically significant difference in PCT level between neutrophile granulocyte levels and different disease types(P>0.05),while the CRP level in the neutrophile granulocyte deficiency group was significantly higher than that in the neutrophile granulocytopenia group and the neutrophile non-granulocytopenia group(P<0.05),there was no statistically significant difference in CRP between different disease types(P>0.05).(5)The PCT of patients with gram-negative bacteria(G-)infection was significantly higher than that of patients with gram-positive bacteria(G+)infection[2.38(0.60-5.83)ng/ml vs.0.25(0.08-0.49)ng-ml],and the difference was statistically significant(P<0.05),while the difference in CRP between the two groups was not statistically significant(P>0.05).(6)According to ROC curve,the AUC of MDIB diagnosed by PCT and CRP was 0.729 and 0.495,respectively.The difference in PCT was statistically significant(P<0.05),while the difference in CRP was not statistically significant(P>0.05).When the cut-off value of PCT detection was 1.305 ng/mL,the sensitivity and specificity were 52.5%and 86.2%,the Youden index was 0.387,the negative and positive predictive values were 85.5%and 53.8%,the negative and positive likelihood ratios were 0.55 and 3.79,respectively.When the cut-off value of CRP detection was 125.085 mg/L,the sensitivity and specificity were 32.5%and 79.2%,the Youden index was 0.117,the negative and positive predictive values were 79.2%and 32.5%,respectively,and the negative and positive likelihood ratios were 0.85 and 1.56,respectively.Conclusion:(1)In patients with malignant hematological tumors and fever,PCT has certain application value in differentiating infectious fever,especially in patients in the bacteremia group(MDIB)with significantly elevated PCT levels,however,CRP is of little significance in identifying infectious fever,and PCT has better diagnostic value than CRP.(2)The detection of PCT was not affected by the type of underlying disease,but PCT was significantly higher in patients with high fever than in those with moderate fever,and PCT synthesis was inhibited to some extent in patients with significantly reduced leukocytes.CRP was significantly higher in the agranulocytosis group than in the non-agranulocytosis group,and there was no significant difference between different disease types and degrees of fever.(3)PCT has a suggestive role in the identification of the type of bacterial bloodstream infection,particularly in the case of Gram-negative bacterial infections,where PCT is particularly elevated,while CRP is not significantly different(4)PCT was significantly superior to CRP in the evaluation of the diagnostic efficacy of bacterial bloodstream infections.When the PCT cutoff value was 1.305 ng/mL,it had the maximum Youden index(0.387)on its ROC curve,with a sensitivity and specificity of 52.5%and 86.2%,respectively.CRP has poor predictive value for bacterial bloodstream infections.