Clinical Implications of Elevated Initial Procalcitonin Levels in Febrile Patients with Pancreatic Cancer

Background/Aim: Pyogenic infections are common in pancreatic cancer patients with fever. This study evaluated procalcitonin as a biomarker for bacterial infection in this population.Methods: A retrospective study was conducted at Seoul National University Bundang Hospital on 149 pancreatic cancer patients who experienced 199 febrile episodes during hospitalization in 2021. The diagnostic performance of white blood cell (WBC) count, C-reactive protein (CRP), and procalcitonin was assessed using receiver operating characteristic curve analysis and area under the curve (AUC).Results: Among 199 febrile episodes, 57.3% occurred in patients with metastatic disease. The most common cause of fever was cholangitis (22.6%), followed by pneumonia (10.1%). Positive blood cultures were more frequent in patients with elevated procalcitonin (51.7% vs. 14.9%, p<0.001). Gram-negative infections were more common in the high procalcitonin group, while culture-negative cases predominated in the low group. Procalcitonin showed stronger correlation with CRP (r=0.31) than with WBC (r=0.16). AUCs were 0.550 (WBC), 0.580 (CRP), and 0.763 (procalcitonin). Patients with procalcitonin ≥1.84 ng/mL had longer hospital stays (9.36 vs. 7.37 days; p=0.0266).Conclusions: Procalcitonin showed the highest diagnostic accuracy for bacterial infection in febrile pancreatic cancer patients and may help guide antibiotic decisions.