Comparison of diagnostic and prognostic utility of lactate and procalcitonin for sepsis in adult cancer patients presenting to emergency department with systemic inflammatory response syndrome

Esra Keçe; Elif Yaka; Serkan Yılmaz; Nurettin Özgür Doğan; Cansu Alyeşil; Murat Pekdemir

doi:10.1016/j.tjem.2016.02.003

Esra Keçe, Elif Yaka, Serkan Yılmaz, Nurettin Özgür Doğan, Cansu Alyeşil, Murat Pekdemir

Department of Emergency Medicine, School of Medicine, Kocaeli University, Turkey

Keywords: Cancer; Sepsis; Lactate; Procalcitonin

Abstract

Objectives: Differentiating sepsis from other noninfectious causes of systemic inflammatory response syndrome (SIRS) in cancer patients is often challenging. Although lactate and procalcitonin have been studied extensively regarding sepsis management, little is known about their utility in cancer patients.

This study aimed to compare the diagnostic and prognostic utility of lactate and procalcitonin for sepsis in cancer patients.

Material and methods: This prospective case-control study was conducted with adult cancer patients presenting to emergency department (ED) with at least two SIRS criteria. The infection status of each patient was determined retrospectively.

Main diagnostic variables were calculated for diagnostic and prognostic utilities of lactate and procalcitonin.

Results: Among 86 patients, mean age was 61. Twenty-two (25.6%) were determined in the sepsis group.

In the ROC analysis, a lactate value of 1 mmol/L predicted sepsis with 86.36% (95%CI: 65.1%–97.1%) sensitivity and 28.12% (95%CI: 17.6%–40.76%) specificity. A procalcitonin value of 0.8 ng/mL yielded a sensitivity of 63.64% (95%CI: 40.7%–82.8%) and 76.56% (95%CI: 63.4%–86.2%) specificity for differential diagnosis of sepsis in cancer patients.

Lactate and procalcitonin showed similar abilities in differentiating sepsis from non-infective SIRS in cancer patients [AUROCs of 0.638 (95%CI:0.527–0.739) vs 0.637 (95%CI:0.527–0.738), respectively. p = 0.994].

They were also similar in predicting poor clinical outcome with AUROCs of 0.629 (95%CI:0.518–0.731) and 0.584 (95%CI: 0.473–0.69), respectively (p = 0.577).

Conclusions: The results of this study indicated that, none of the lactate and procalcitonin can be recommended alone to differentiate sepsis from non-infectious SIRS and to predict the poor clinical outcomes in adult cancer patients with SIRS in the ED.