Evaluating the role of C-reactive protein and procalcitonin in risk stratification and outcomes of febrile neutropenia in solid malignancies.

Abstract

e24080 Background: C-reactive protein (CRP) and procalcitonin (PCT) are widely used during inpatient admissions for febrile neutropenia (FN). However, neither of these biomarkers is included in the clinically validated Multinational Association for Supportive Care (MASCC) risk index, which limits their utility in risk stratification and outcome prediction. This study evaluated the role of CRP and PCT in predicting clinical outcomes in patients with FN and solid malignancies, focusing on key outcomes such as length of stay (LOS), antibiotic duration, and mortality. The secondary objective was to assess these biomarkers' correlation with the MASCC risk index and their effect on its predictive accuracy. Methods: We conducted a prospective observational study at Aga Khan University Hospital, Karachi, Pakistan, from June 2023 to September 2024. A total of 100 adult patients with solid malignancies admitted with FN were included. Demographic and clinical data were recorded, and patients were stratified by MASCC risk index. Median CRP and PCT levels were compared using the Mann-Whitney U test. Logistic regression assessed associations between biomarkers and outcomes (mortality, LOS antibiotic duration), reported as odds ratios (OR) with 95% confidence intervals (CI). ROC analysis evaluated biomarker predictive accuracy. Analyses were performed using Stata, with p < 0.05 considered significant. Results: Of the 100 patients, n = 49 were identified as low risk (MASCC ≥21). The mean age was 54 years, with high-risk patients (MASCC < 21) being older (mean 58 years) compared to low-risk patients (mean 50 years). The median PCT levels were 0.8 and CRP levels were 15.5. PCT levels were significantly associated with several clinical outcomes. Patients with elevated PCT levels had a longer LOS (p < 0.05) and required extended durations of antibiotic therapy (p < 0.05), indicating a link between higher biomarker levels and more severe infections. Elevated PCT levels were also significantly associated with increased mortality risk (p < 0.05, OR: 10.91, 95% CI: [1.26, 94.52]), underlining its prognostic value. CRP showed weaker associations and limited prognostic utility. In terms of risk stratification, PCT levels demonstrated a significant association with the MASCC score (p < 0.05) and MASCC risk classification (p < 0.05), suggesting its potential role in enhancing the MASCC scoring system’s predictive accuracy. Conclusions: PCT has significant predictive value for LOS, antibiotic duration, and mortality, while also showing a strong association with MASCC risk index. These findings highlight the potential role of incorporating PCT into FN risk stratification and management protocols. Larger prospective studies should explore the integration of PCT with the MASCC risk index, enabling improved identification of high-risk patients prone to FN-related complications.