Procalcitonin as a Predictive Tool for Death and ICU Admission among Febrile Neutropenic Patients Visiting the Emergency Department
<i>Background and Objectives</i>: Risk stratification tools for febrile neutropenia exist but are infrequently utilized by emergency physicians. Procalcitonin may provide emergency physicians with a more objective tool to identify patients at risk of decompensation. <i>Materials an...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-07-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/58/8/985 |
| _version_ | 1797409018925285376 |
|---|---|
| author | Christopher J. Coyne Edward M. Castillo Rebecca A. Shatsky Theodore C. Chan |
| author_facet | Christopher J. Coyne Edward M. Castillo Rebecca A. Shatsky Theodore C. Chan |
| author_sort | Christopher J. Coyne |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Risk stratification tools for febrile neutropenia exist but are infrequently utilized by emergency physicians. Procalcitonin may provide emergency physicians with a more objective tool to identify patients at risk of decompensation. <i>Materials and Methods</i>: We conducted a retrospective cohort study evaluating the use of procalcitonin in cases of febrile neutropenia among adult patients presenting to the Emergency Department compared to a non-neutropenic, febrile control group. Our primary outcome measure was in-hospital mortality with a secondary outcome of ICU admission. <i>Results</i>: Among febrile neutropenic patients, a positive initial procalcitonin value was associated with significantly increased odds of inpatient mortality after adjusting for age, sex, race, and ethnicity (AOR 9.912, <i>p</i> < 0.001), which was similar, though greater than, our non-neutropenic cohort (AOR 2.18, <i>p</i> < 0.001). All febrile neutropenic patients with a positive procalcitonin were admitted to the ICU. Procalcitonin had a higher sensitivity and negative predictive value (NPV) in regard to mortality and ICU admission for our neutropenic group versus our non-neutropenic control. <i>Conclusions</i>: Procalcitonin appears to be a valuable tool when attempting to risk stratify patients with febrile neutropenia presenting to the emergency department. Procalcitonin performed better in the prediction of death and ICU admission among patients with febrile neutropenia than a similar febrile, non-neutropenic control group. |
| first_indexed | 2024-03-09T04:08:14Z |
| format | Article |
| id | doaj.art-f6bf99032b564cc88f1e4a380b1ed5d9 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T04:08:14Z |
| publishDate | 2022-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-f6bf99032b564cc88f1e4a380b1ed5d92023-12-03T14:04:16ZengMDPI AGMedicina1010-660X1648-91442022-07-0158898510.3390/medicina58080985Procalcitonin as a Predictive Tool for Death and ICU Admission among Febrile Neutropenic Patients Visiting the Emergency DepartmentChristopher J. Coyne0Edward M. Castillo1Rebecca A. Shatsky2Theodore C. Chan3Department of Emergency Medicine, University of California San Diego, San Diego, CA 92103, USADepartment of Emergency Medicine, University of California San Diego, San Diego, CA 92103, USADepartment of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, CA 92037, USADepartment of Emergency Medicine, University of California San Diego, San Diego, CA 92103, USA<i>Background and Objectives</i>: Risk stratification tools for febrile neutropenia exist but are infrequently utilized by emergency physicians. Procalcitonin may provide emergency physicians with a more objective tool to identify patients at risk of decompensation. <i>Materials and Methods</i>: We conducted a retrospective cohort study evaluating the use of procalcitonin in cases of febrile neutropenia among adult patients presenting to the Emergency Department compared to a non-neutropenic, febrile control group. Our primary outcome measure was in-hospital mortality with a secondary outcome of ICU admission. <i>Results</i>: Among febrile neutropenic patients, a positive initial procalcitonin value was associated with significantly increased odds of inpatient mortality after adjusting for age, sex, race, and ethnicity (AOR 9.912, <i>p</i> < 0.001), which was similar, though greater than, our non-neutropenic cohort (AOR 2.18, <i>p</i> < 0.001). All febrile neutropenic patients with a positive procalcitonin were admitted to the ICU. Procalcitonin had a higher sensitivity and negative predictive value (NPV) in regard to mortality and ICU admission for our neutropenic group versus our non-neutropenic control. <i>Conclusions</i>: Procalcitonin appears to be a valuable tool when attempting to risk stratify patients with febrile neutropenia presenting to the emergency department. Procalcitonin performed better in the prediction of death and ICU admission among patients with febrile neutropenia than a similar febrile, non-neutropenic control group.https://www.mdpi.com/1648-9144/58/8/985procalcitoninfebrile neutropenianeutropenic feveremergency departmentoncologic emergenciescancer |
| spellingShingle | Christopher J. Coyne Edward M. Castillo Rebecca A. Shatsky Theodore C. Chan Procalcitonin as a Predictive Tool for Death and ICU Admission among Febrile Neutropenic Patients Visiting the Emergency Department Medicina procalcitonin febrile neutropenia neutropenic fever emergency department oncologic emergencies cancer |
| title | Procalcitonin as a Predictive Tool for Death and ICU Admission among Febrile Neutropenic Patients Visiting the Emergency Department |
| title_full | Procalcitonin as a Predictive Tool for Death and ICU Admission among Febrile Neutropenic Patients Visiting the Emergency Department |
| title_fullStr | Procalcitonin as a Predictive Tool for Death and ICU Admission among Febrile Neutropenic Patients Visiting the Emergency Department |
| title_full_unstemmed | Procalcitonin as a Predictive Tool for Death and ICU Admission among Febrile Neutropenic Patients Visiting the Emergency Department |
| title_short | Procalcitonin as a Predictive Tool for Death and ICU Admission among Febrile Neutropenic Patients Visiting the Emergency Department |
| title_sort | procalcitonin as a predictive tool for death and icu admission among febrile neutropenic patients visiting the emergency department |
| topic | procalcitonin febrile neutropenia neutropenic fever emergency department oncologic emergencies cancer |
| url | https://www.mdpi.com/1648-9144/58/8/985 |
| work_keys_str_mv | AT christopherjcoyne procalcitoninasapredictivetoolfordeathandicuadmissionamongfebrileneutropenicpatientsvisitingtheemergencydepartment AT edwardmcastillo procalcitoninasapredictivetoolfordeathandicuadmissionamongfebrileneutropenicpatientsvisitingtheemergencydepartment AT rebeccaashatsky procalcitoninasapredictivetoolfordeathandicuadmissionamongfebrileneutropenicpatientsvisitingtheemergencydepartment AT theodorecchan procalcitoninasapredictivetoolfordeathandicuadmissionamongfebrileneutropenicpatientsvisitingtheemergencydepartment |