2153P - Circulating biomarkers to predict severe complications in cancer patients with low-risk chemotherapy-associated febrile neutropenia

Background

Febrile neutropenia (FN) is one of the most frequent and life-threatening complications in cancer patients. The most widely used model to identify low-risk FN episodes, candidates for outpatient management, is the Multinational Association for Supportive Care in Cancer (MASCC). However, its ability to predict serious complications is not optimal, occurring in up to 15% of episodes classified as low risk. The identification of circulating biomarkers may refine these indexes. We aimed to evaluate the role of C-reactive protein (CRP) and procalcitonin (PCT) in predicting the development of serious complications in low-risk FN episodes.

Methods

A retrospective study including FN episodes in patients with solid tumors presenting to the Emergency Department (ED), classified as low risk (MASCC score ≥ 21). In all episodes, a blood sample was collected on admission to the ED for analysis, including CRP and PCT. Outcome was defined as Intensive Care Unit (ICU) admission and/or death and/or other serious complications. To evaluate the discriminatory ability of biomarkers for outcome, Receiver Operating Characteristic (ROC) curve analysis was used and optimal cutoffs were calculated through Youden index.

Results

During the study period, 132 low-risk episodes were included (mean age: 58.4; SD: 11.5 years; 83 (62.9%) female). Serious complications were developed in 52 (39.4%) episodes. Median CRP and PCT levels were significantly higher in patients developing complications: 11.8 mg/dL (IQR: 5.21-19.6) vs 5.3 mg/dL (IQR: 2.2-9.0), p < 0.001; 0.42 ng/mL (IQR: 0.14-1.09) vs 0.12 ng/mL (0.06-0.23), p < 0.001, respectively. In ROC AUC analysis, both biomarkers achieved a similar predictive accuracy (CRP: 0.733 and PCT: 0.744). Optimal cutoffs were 9.8 mg/dL for CRP (Sensitivity (S): 61.5%, Specificity (Sp): 80%, positive predictive value (PPV): 66.7% and negative (NPV): 76.2%) and 0.27 ng/mL for PCT (S: 61.5%, Sp: 81.3%, PPV: 68.1%, NPV: 76.5%).

Conclusions

In chemotherapy-associated FN patients, circulating CRP and PCT levels might be useful to improve the risk stratification of low-risk episodes, contributing to decision making in the management of these patients.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.