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Assessment of systemic inflammation markers to differentiate a stable from a deteriorating clinical course in patients with febrile neutropenia

In this study, we evaluated the predictive values of procalcitonin (PCT), C‐reactive protein (CRP), interleukin‐6 (IL‐6) and serum amyloid A (SAA) for determining the clinical course in febrile neutropenic patients. Daily plasma analyses during the fever course were performed in 101 episodes with fever and chemotherapy‐induced neutropenia (neutrophil count <0.5 × 109/L). Procalcitonin (PCT) and IL‐6 values were significantly higher in febrile episodes in patients who developed complications. Procalcitonin with a cut‐off value of ≤0.4 ng/mL or IL‐6 ≤50 pg/mL 3 d after fever onset indicated daily high negative predictive values (NPVs) (91–100%) for episodes with complications. No marker could predict deterioration; however, daily low plasma concentrations of PCT or IL‐6 during the first 8 d of fever were found to be a good predictor of no subsequent complications in neutropenic patients and therefore to be a helpful tool for limiting anti‐microbial therapy.