Marked Elevation in Serum Procalcitonin Levels Do Not Correlate With Severity of Disease or Mortality in Hospitalized Patients: A Retrospective Study

Costs and Consequences of a Novel Emergency Department Sepsis Diagnostic Test: The IntelliSep Index

Sepsis causes 270,000 deaths and costs $38 billion annually in the United States. Most cases of sepsis present in the emergency department (ED), where rapid diagnosis remains challenging. The IntelliSep Index (ISI) is a novel diagnostic test that analyzes characteristics of WBC structure and provides a reliable early signal for sepsis. This study performs a cost-consequence analysis of the ISI relative to procalcitonin for early sepsis diagnosis in the ED.

PERSPECTIVE

U.S. healthcare system.

SETTING

Community hospital ED.

METHODS

A decision tree analysis was performed comparing ISI with procalcitonin. Model parameters included prevalence of sepsis, sensitivity and specificity of diagnostic tests (both ISI and procalcitonin), costs of hospitalization, and mortality rate stratified by diagnostic test result. Mortality and prevalence of sepsis were estimated from best available literature. Costs were estimated based on an analysis of a large, national discharge dataset, and adjusted to 2018 U.S. dollars. Outcomes included expected costs and survival.

RESULTS

Assuming a confirmed sepsis prevalence of 16.9% (adjudicated to Sepsis-3), the ISI strategy had an expected cost per patient of $3,849 and expected survival rate of 95.08%, whereas the procalcitonin strategy had an expected cost of $4,656 per patient and an expected survival of 94.98%. ISI was both less costly and more effective than procalcitonin, primarily because of fewer false-negative results. These results were robust in sensitivity analyses.

CONCLUSIONS

ISI was both less costly and more effective in preventing mortality than procalcitonin, primarily because of fewer false-negative results. The ISI may provide health systems with a higher-value diagnostic test in ED sepsis evaluation. Additional work is needed to validate these results in clinical practice.

Use of serum procalcitonin (PCT) level and PCT mRNA expression as a potential clinical biomarker in cats with bacterial and viral infections

OBJECTIVES

The aim of this study was to investigate the use of procalcitonin (PCT) as a biomarker in differentiating bacterial infections from viral infections in cats. In addition, the relationship between PCT and mortality rate was also examined.

METHODS

Forty-five cats were included in the study. The cats were categorised into two groups: bacterial (n = 20) and viral (n = 25) infection. Serum PCT level and PCT mRNA expression were analysed from blood samples collected before treatment.

RESULTS

Serum PCT level and PCT mRNA expression of the cats with presumed bacterial infection were higher than those with viral infection (P = 0.001 and P = 0.001, respectively). The receiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve value of 0.888 for serum PCT and 0.850 for PCT mRNA expression. There was no statistically significant difference among respiratory, urinary and gastrointestinal tract infections regarding serum PCT level and PCT mRNA expression in the presumed bacterial infection group (P = 0.741 and P = 0.141, respectively). In the presumed bacterial infection group, serum PCT level and PCT mRNA expression in the non-surviving cats were higher than those of the surviving cats (P = 0.021 and P = 0.026, respectively).

CONCLUSIONS AND RELEVANCE

Serum PCT level and PCT mRNA expression were considered efficient biomarkers in cats to distinguish a bacterial infection from a viral infection. Moreover, ROC curve analysis was highly accurate in the discriminative capacity of these two parameters. PCT level and PCT mRNA expression offer substantial assistance in an efficient therapeutic approach and in avoiding unnecessary antibiotic use in feline clinical practice, particularly in emergency patients and those with non-specific clinical signs, decreasing the mortality rate. However, it should be noted that these data are only research data. More detailed future studies are needed.

Procalcitonin prognostic value in predicting mortality among adult patients with sepsis due to Gram-negative bacteria

BACKGROUND Sepsis is a leading cause of mortality and morbidity globally. Gram-negative bacteremia was reported to have a high risk of septic shock and poor prognosis. This study aimed to evaluate the role of procalcitonin in predicting mortality in patients with sepsis due to Gram-negative bacteria. METHODS This was a retrospective cohort study performed based on medical records and sepsis registry of Tropical and Infectious Disease Division, Department of Internal Medicine, Cipto Mangunkusumo Hospital. The inclusion criteria were patients aged ≥18 years diagnosed with sepsis due to Gram-negative bacteria based on blood culture on admission and hospitalized between March 2017 and October 2020. Data taken from medical records included subjects’ characteristics, laboratory parameters, and 28-day mortality outcomes during hospitalization. Receiver operating characteristic was used to determine the area under the curve (AUC) of procalcitonin and its accuracy. RESULTS A total of 128 patients were eligible. The cumulative survival of patients with Gram-negative bacteremia was 48.4% (standard error 0.96%). The AUC of procalcitonin to predict mortality was 0.45 (95% confidence interval 0.36–0.54). Escherichia coli was the predominant microorganism in blood culture (n = 38, 29.7%). CONCLUSIONS Procalcitonin has a poor performance in predicting mortality of patients with sepsis due to Gram-negative bacteria.