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Plasma Cytokines Augment Procalcitonin in Predicting Bloodstream Infections in Cancer Patients Admitted to an Oncologic ICU FREE TO VIEW

Sherard Lacaille, MBBS; Stephen Pastores, MD; Natalie Kostelecky, RN; Damodara Mendu, MD; Sun Cho; Lakshmi Ramanathan, PhD; Martin Fleisher, PhD; Neil Halpern, MD
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Memorial Sloan Kettering Cancer Center, New York, NY

Chest. 2015;148(4_MeetingAbstracts):353A. doi:10.1378/chest.2240702
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To validate the utility of procalcitonin (PCT) and 5 plasma cytokines (TNF-α, IL-1β, IL-6, IL-8, IFN-γ) in predicting bloodstream infections (BSIs) in cancer patients admitted to an ICU with suspected or documented sepsis at a tertiary cancer center.

METHODS: We retrospectively studied the clinical, laboratory, and outcome data of 69 adult cancer patients who were admitted to the ICU between October 2012 and September 2014 and met our sepsis inclusion criteria. An additional 19 non­-septic patients served as controls. Serum PCT and plasma TNF-α, IL-1β, IL-6, IL-8, and IFN-γ levels were measured within 24 h of ICU admission, at 48-72 h, and daily through day 7 unless the patient expired or was discharged from the ICU. Documented BSI within 48 hours of ICU admission was the primary outcome. The diagnostic performance of PCT and each of the 5 cytokines on Day 1 of ICU admission in patients with severe sepsis/septic shock were evaluated by constructing the receiver operating characteristic (ROC) curve and estimating the area under the curve (AUC) for each test and PCT in combination with each of the cytokines.

RESULTS: Of the 69 patients, 44 (64%) were male and the mean age was 64 years (range 21-89). 49 (71%) had solid tumor and 20 (29%) hematologic malignancy. 7 (10%) had SIRS, 5 (7%) sepsis, and 57 (83%) had severe sepsis or septic shock. Mean lactate, MPM II and SOFA scores on ICU admission were 3.7 mmol/L, 40% and 7.7, respectively. Overall ICU and hospital mortality rates were 28% and 39%, respectively. In all, 24 (34%) had documented BSIs. The AUC for a documented BSI was greatest when Day 1 PCT was combined with IFN-γ (0.80, 95% CI 0.56-0.83) followed by PCT combined with all 5 cytokines (0.78, 95% CI 0.66-0.89) compared to PCT alone (0.67, 95% CI 0.53-0.82). The AUC for predicting patients with severe sepsis/septic shock was also greater when PCT was combined with all 5 cytokines (0.86, 95% CI 0.77-0.95) compared with PCT alone (0.81, 95% CI 0.69-0.94).

CONCLUSIONS: In critically ill cancer patients, plasma cytokines augment PCT levels on Day 1 in predicting BSIs and correlated with presentation with severe sepsis/septic shock.

CLINICAL IMPLICATIONS: Prospective larger studies are needed to confirm the above findings.

DISCLOSURE: The following authors have nothing to disclose: Sherard Lacaille, Stephen Pastores, Natalie Kostelecky, Damodara Mendu, Sun Cho, Lakshmi Ramanathan, Martin Fleisher, Neil Halpern

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