Evolution of procalcitonin, C‐reactive protein and fibrinogen levels in neutropenic leukaemia patients with invasive pulmonary aspergillosis or mucormycosis

Summary Unlike bacterial infections, the value of procalcitonin ( PCT ) in detecting fungal infections in leukaemia patients is not clear. To determine whether the monitoring of PCT coupled with C‐reactive protein ( CRP ) and fibrinogen (Fib) could be helpful in the management of pulmonary aspergillosis ( IPA ) or mucormycosis ( PM ), we retrospectively analysed the evolution of PCT , CRP and Fib levels in 94 leukaemia patients with proven/probable IPA ( n = 77) or PM ( n = 17) from D−12 to D12 relative to IFI onset defined as D0. Overall, 2140 assays were performed. From D−12 to D0, 12%, 5% and 1.4% of patients had PCT >0.5, 1 and 1.5 μg l −1 , respectively, while CRP was >50, 75 and 100 mg l −1 in 84%, 70% and 57% and Fib was >4, 5 and 6 g l −1 in 96%, 80% and 61% of cases respectively ( P < 10 −7 ). The same trends were observed from D1 to D12. Overall, between D−12 and D12, only 6.4% of patients had PCT >1.5 μg l −1 , while CRP >100 mg l −1 and Fib >6 g l −1 were observed in 80% and 75% of cases respectively ( P < 10 −7 ). In leukaemia patients, IPA or PM was accompanied by a significant increase in CRP and Fib while PCT remained low.