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The ability of inflammatory markers to recognize infection in cancer patients with fever at admission

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Abstract

Infection is one of the main causes of death in cancer patients. Accurate identification of fever caused by infection could avoid unnecessary antibiotic treatment and hospitalization. This study evaluated the diagnostic value of procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and other commonly used inflammatory markers in suspected infected adult cancer patients with fever, for better use of antibiotics. This research retrospective analyzed the clinical data of 102 adult cancer patients with fever and compared the serum levels of commonly used inflammatory markers for different fever reasons. Receiver-operating characteristic (ROC) curve and logistic regression analyses were performed. In adult cancer patients with fever, the serum PCT, CRP, IL-6, and IL-10 levels of infected patients were significantly higher than uninfected patients (median 1.19 ng/ml vs 0.14 ng/ml, 93.11 mg/l vs 56.55 mg/l, 123.74 pg/ml vs 47.35 pg/ml, 8.74 pg/ml vs 3.22 pg/ml; Mann–Whitney p = 0.000, p = 0.009, p = 0.004, p = 0.000, respectively). The ROC area under the curve(AUC) was 0.769 (95% confidence interval (CI) 0.681–0.857; p = 0.000) for PCT, 0.664 (95% CI 0.554–0.775; p = 0.009) for CRP, 0.681(95% CI 0.576–0.785; p = 0.004) for IL-6, and 0.731(95% CI 0.627–0.834; p = 0.000) for IL-10. PCT had specificity of 96.67% and positive predictive value (PPV) of 97.6%, when the cut-off value is set as 0.69 ng/ml. The serum IL-6 and IL-10 levels also had significant differences between the infected and uninfected cancer patients with advanced disease (median 128.92 pg/ml vs 36.40 pg/ml, 8.05 pg/ml vs 2.92 pg/ml; Mann–Whitney p = 0.003, p = 0.001, respectively). For the patients with neutropenia, IL-6 and IL-10 had higher AUC of 0.811 and 0.928, respectively. With a cut-off of 9.10 pg/ml, IL-10 had the highest sensitivity 83.33% and specificity 100%. In adult cancer patients, PCT had the best performance compared to CRP, IL-6, and IL-10 in differentiating infected from uninfected causes of fever, with high specificity and PPV. IL-6 and IL-10 might be useful in cancer patients with severe bloodstream infections and advanced disease. However, for patients with neutropenia, IL-10 might be more valuable than PCT in diagnosing infection.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

PCT:

Procalcitonin

CRP:

C-reactive protein

WBC:

White blood cell count

Ns:

Neutrophils

IL:

Interleukin

TNF-α:

Tumor necrosis factor α

INF-γ:

Interferon γ

ROC:

Receiver-operating characteristic

AUC:

Area under the curve

NPV:

Negative predictive value

PPV:

Positive predictive value

PLR:

Positive likelihood ratio

NLR:

Negative likelihood ratio

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Funding

This work was supported by the Key R&D Project of Sichuan Provincial Department of Science and Technology (Grant numbers [2022ZYF1927]) and the Key R&D Project of Chengdu Science and Technology Bureau (Grant numbers [YF05-01792-SN]).

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Authors and Affiliations

  1. Department of Clinical Laboratory, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No. 55, Section 4, Renmin South Road, Wuhou District, Chengdu City, Sichuan Province, China

    Lubei Rao, Kaijiong Zhang, Huaichao Luo, Shuya He, Yuping Li, Chang Liu & Dongsheng Wang

  2. Department of Information, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

    Ying Yang

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  1. Lubei Rao
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  2. Kaijiong Zhang
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  4. Shuya He
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Contributions

All the authors contributed to the study’s conception and design. Material preparation was performed by Lubei Rao and Chang Liu. The methodology was performed by Shuya He and Yuping Li. Data collection and analysis were performed by Lubei Rao, Ying Yang, Kaijiong Zhang, and Huaichao Luo. The first draft of the manuscript was written by Dongsheng Wang. All the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Dongsheng Wang.

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The research related to human use has been complied with all the relevant national regulations, institutional policies and follows the tenets of the Helsinki Declaration, and has been approved by the Institutional Ethics Committee of The Sichuan Cancer Hospital. The study was a retrospective analysis and does not require the patient’s informed consent.

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The authors declare no competing interests.

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The authors have no relevant financial or non-financial interests to disclose. The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Rao, L., Zhang, K., Luo, H. et al. The ability of inflammatory markers to recognize infection in cancer patients with fever at admission. Immunol Res 70, 667–677 (2022). https://doi.org/10.1007/s12026-022-09299-4

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