The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

Abstract

Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

PCT testing in sepsis protocols

“…In general, the articles concluded that the PCT is a positive predictor for progression to sepsis, more specific than standard lactic acid or CRP tests included in current protocols. Publications reviewing the effectiveness of sepsis biomarkers also noted that early initiation of antibiotics in patients with an elevated PCT helped to reduce mortality and length of hospital stay (Hohn et al, 2018;Wirz et al, 2018;Chow et al, 2021;Niederman et al, 2021;De Oro et al, 2019).…”

Procalcitonin and C-reactive protein as early predictors in patients at high risk of colorectal anastomotic leakage

“… 40 After major abdominal, vascular, or thoracic operations, patients often exhibit elevated concentrations of PCT on PODs 1 and 2. 41 Conversely, patients who have undergone minor, aseptic procedures tend to have lower PCT levels. 42 – 44 This suggests that PCT may be triggered by transient bacterial contamination or bacterial translocation that occurs during the operation or preparation of intestinal anastomoses.…”

Study on the expression of TRIM7 in peripheral blood mononuclear cells of patients with sepsis and its early diagnostic value

“…Early identification of whether patients with infection may progress to sepsis or even septic shock is very important for guiding clinical treatment [ 5 ]. Commonly used indicators for evaluating the severity of infection and inflammation include white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT) [ 6 ], tumor necrosis factor (TNF)-α and interleukin (IL)-6 [ 7 ], etc. Clinical studies have shown that the above indicators have some defects in sensitivity or specificity.…”