Procalcitonin Screening Helps Provide Early Identification of Sepsis

In a retrospective study of a large and diverse population of critically ill patients, researchers have found that screening for sepsis by procalcitonin (PCT) testing at admission to intensive care unit (ICU) notably reduced the hospitalization length-of-stay and total cost of care. The study clearly suggests that PCT screening on the first day of ICU admission is a potentially important diagnostic tool.

An often-fatal condition, sepsis affects millions of people each year. Currently, there is not an accepted “gold standard” test for determining whether a patient has sepsis, so the disease presents a diagnostic challenge. An incorrect sepsis diagnosis can result in poor patient outcomes linked to the unnecessary use of antibiotics, including increased length of hospital stay, C. difficile infections, and higher than necessary healthcare costs. Early identification of sepsis patients can help combat negative outcomes also in that proper treatment techniques can be implemented immediately.

In an effort to find novel diagnostic approaches, PCT screening has recently gained momentum as a viable screening tool. The new study examined whether testing for PCT, a precursor of calcitonin, would help to more effectively manage care.

“Despite the emergence of PCT as a diagnostic criterion for sepsis in the 2012 Surviving Sepsis Guidelines, PCT testing has not been uniformly adopted, in part because of cost considerations,” explained lead investigator Prof. Dr. Robert A. Balk, MD, of Rush Medical College and Rush University Medical Center, “This study demonstrated that the use of PCT testing on the first day of ICU care was associated with significantly lower hospital and ICU length of stay. There was also a significant difference in the total hospital, ICU and pharmacy costs when day one PCT testing was used in adult critically ill patients.”

The retrospective study examined 15,041,827 patient cases from the Premier Healthcare database, of which 730,088 had a potential sepsis, SIRS, septicemia, or shock-related diagnosis on admission or discharge. All patients included in the study were 18 years of age or older and admitted to the ICU. Patients were divided into 2 groups by whether they had received PCT screening on their first day in the ICU or not. The investigators discovered that PCT-guided care on day-1 was associated with a multitude of positive outcomes including significantly shorter hospital and ICU stays and significantly decreased total hospital, room and board, pharmacy, and antibiotic costs. Despite a slight increase in laboratory costs, they also found that among the PCT patients, antibiotic exposure was lower and they were less likely to be transferred to acute care, skilled nursing, intermediate care, or long-term care facilities.

Furthermore, the study revealed that patients receiving PCT testing on day-1 of ICU admission averaged 1.2 fewer hospital days than patients who were not screened and saved an average of 2,759 USD on their total hospital costs.

“This study is important because it validates the ability of PCT testing to favorably impact outcomes of critically ill patients when used according to the FDA-cleared guideline,” said Dr. Balk, “The study population was quite large and extremely diverse. The use of PCT was evaluated over nearly a 3.5-year period and in a variety of clinical settings including academic and nonacademic institutions. The cost savings were real and consequential, exceeding the potential increased costs of laboratory testing associated with PCT testing on ICU admission.”

“The significance and mechanisms surrounding the observed clinical outcomes warrant additional evaluation,” said Dr. Balk.

The study, by Balk RA et al, was published in the January 2017 issue of the journal CHEST.