# Comparative Analysis of Procalcitonin and C-Reactive Protein in Bloodstream Infections Among Febrile Neutropenic Pediatric Cancer Patients

## TL;DR

This study compares procalcitonin and C-reactive protein for diagnosing bloodstream infections in children with cancer and febrile neutropenia, finding procalcitonin more effective.

## Contribution

The study demonstrates that procalcitonin outperforms C-reactive protein in detecting bloodstream infections in febrile neutropenic pediatric cancer patients.

## Key findings

- Procalcitonin levels were significantly higher in Gram-negative infections compared to Gram-positive infections.
- Procalcitonin showed higher sensitivity and specificity than C-reactive protein for diagnosing bloodstream infections.
- Elevated procalcitonin levels correlated with worse clinical outcomes like ICU admission and longer hospital stays.

## Abstract

Febrile neutropenia is a serious complication in pediatric cancer patients receiving chemotherapy, often leading to bloodstream infections, where early diagnosis is critical. This prospective observational study, conducted at a tertiary care hospital in Northern India from August 2023 to July 2024, included 106 pediatric patients with chemotherapy-induced febrile neutropenia to compare the diagnostic performance of procalcitonin (PCT) and C-reactive protein (CRP). Bloodstream infections were confirmed in 32 patients (30.2%), comprising 20 Gram-negative, 11 Gram-positive, and one fungal isolate. PCT levels were significantly higher in Gram-negative infections (19.27 ± 10.56 ng/mL) than in Gram-positive infections (2.57 ± 2.35 ng/mL, p<0.01), while CRP showed less specificity (150.0 ± 35.2 mg/L vs. 45.0 ± 20.8 mg/L, p<0.05). PCT demonstrated superior diagnostic accuracy (sensitivity 89.2%, specificity 83.5%, AUC 0.93) compared to CRP (sensitivity 76.3%, specificity 62.7%, AUC 0.76). Elevated PCT levels correlated with higher intensive care admissions, prolonged hospital stays, and delayed antibiotic de-escalation (p<0.001). These findings indicate that PCT is a more reliable biomarker than CRP for early detection of bloodstream infections in febrile neutropenic pediatric cancer patients, particularly for Gram-negative bacteremia, and its routine incorporation may enhance infection management and clinical outcomes in pediatric oncology.