Publication

Abstract : Introduction: The utility of serially measuring C-reactive protein and procalcitonin in patients undergoing hematopoetic stem cell transplantation is debatable. IDSA recommends against routinely measuring these biomarkers in febrile neutropenic patients. We retrospectively analysed the utility of this approach in our patients. Aims: To assess the impact of peak and median CRP and procalcitonin values on survival of febrile patients undergoing HSCT. Methods: From December 2015 to to July 2019, 44 patients underwent 47 transplants (Autologous-9, Allogenic- 38, haploidentical -16). Patients who had fever and had 4 or more serial measurements for CRP and procalcitonin were included in the analysis. For CRP, 28 patients and for procalcitonin 14 patients were eligible for analysis. Survival was analysed with respect to median as well as peak CRP and procalcitonin levels. Results: Median CRP values ranged from 0.74-24.19 mg/dl while peak CRP values ranged from 3.02 -47.5 mg/dl. Median and peak procalcitonin levels ranged from 0.05-18.38 ng/ml and 0.05-36.28 ng/ml respectively. At a median follow up of 10 months patients with peak CRP ≥ 15 had a significantly poorer survival, 62 % (0.26-0.85, p <0.018) vs 100 %. The mortality rate was 0/15 in patients with lower peak CRP levels vs 4/13 in patients with higher peak CRP levels. Median procalcitonin levels also correlated with survival, survival being 100 % with value <0.32 vs 27 % with value ≥ 0.32. There were no mortalities in the lower procalcitonin subgroup while 3/6 patients died in the higher procalcitonin subgroup. Both median CRP and peak procalcitonin did not impact survival. Conclusion: Serial CRP and procalcitonin measurement in patients with fever, who are undergoing HSCT can be useful in identifying patients who are at a higher risk of early mortality and are candidates for early antibiotic escalation as well as more intensive strategies like granulocyte transfusions.