말기 암환자에서 균혈증 예측인자로써의 프로칼시토닌의 유용성

Procalcitonin as a Diagnostic Marker for Bacteremia in Terminal Cancer Patients

Background: Serum procalcitonin (PCT) levels are elevated in patients with bacteremia, and in those with neoplasms or imminent death, regardless of their infection status. We aimed to assess whether serum PCT levels can be used to diagnose bacteremia in terminal cancer patients. Methods: We analyzed 106 patients for whom PCT, C-reactive protein, erythrocyte sedimentation rate, white blood cell counts, and blood culture were concurrently requested in a hospice/palliative care center at a university hospital from January 1, 2014 to December 31, 2015. The factors affecting positive blood culture results were assessed using a multivariable logistic regression model. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the usefulness of the serum PCT levels as a diagnostic marker for bacteremia, and the PCT cut-off level for predicting positive blood cultures was determined. Results: We recruited 58 male (54.7%) and 48 female (45.2%) patients. The mean serum PCT level was 3.68±12.77 ng/mL. There was significant correlation between the serum PCT levels in the prediction of positive blood cultures in terminal cancer patients (P=0.024), and after adjusting for confounding variables, there was significant correlation between the serum PCT levels and bacteremia (P=0.021). Furthermore, a ROC curve analysis was performed to investigate the usefulness of the serum PCT levels in the prediction of positive blood cultures. The area under the curve of the serum PCT levels was 0.643. Serum PCT levels greater than 1.72 ng/mL can predict positive blood culture results (sensitivity 50.0%, specificity 81.8%).Conclusion: Serum PCT level measurement is useful for predicting positive blood cultures in terminal cancer patients.