Predictive Value of Procalcitonin and C-Reactive Protein Ratios for Bacteremia in Febrile Neutropenic Cancer Patients: A Meta-Analysis
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Background: Febrile neutropenia is a potentially life-threatening complication of cancer therapy in which early recognition of bacteremia is essential, yet clinical signs may be attenuated and blood-culture results are delayed. Procalcitonin (PCT) and C-reactive protein (CRP) are commonly investigated inflammatory biomarkers, but their comparative diagnostic performance and the additional value of PCT/CRP or CRP/PCT ratios remain uncertain. Objective: To systematically evaluate the diagnostic performance of PCT and CRP for detecting bacteremia in cancer patients with febrile neutropenia and to assess evidence for explicit PCT/CRP or CRP/PCT ratio-based measures. Methods: PubMed/MEDLINE, Embase, Scopus, and Web of Science were systematically searched using terms related to febrile neutropenia, malignancy, PCT, CRP, biomarker ratios, bacteremia, and bloodstream infection. Primary studies reporting diagnostic or clinically relevant biomarker data in febrile-neutropenic cancer populations were eligible. Study selection and data extraction were performed independently by two reviewers, and methodological quality was assessed using QUADAS-2. Diagnostic findings were synthesized descriptively because thresholds, populations, and reporting formats were heterogeneous and compatible 2×2 data were not consistently available for hierarchical pooling. Results: Five relevant primary studies were identified, of which four provided clearly separable febrile-neutropenic data comprising 538 patients or episodes. PCT generally showed stronger discrimination than CRP. Reported PCT AUC values ranged from 0.624 to 0.900, while CRP AUC values ranged from 0.500 to 0.590 in directly comparable febrile-neutropenic cohorts. PCT negative predictive values reached 93.8%, although performance varied substantially across thresholds from 0.20 to 3.25 ng/mL. Evidence for explicit PCT/CRP or CRP/PCT ratios in febrile neutropenia was insufficient for quantitative synthesis. Conclusion: PCT appears more informative than CRP for bacteremia assessment in febrile neutropenia but should be used as an adjunct to clinical and microbiological evaluation. Standardized multicenter studies are required before universal thresholds or ratio-based algorithms can be recommended
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