From the 2024 HVPA National Conference
Noreena Aslam, Internal Medicine Resident, MD (Crozer Chester Medical Center), Aamir Hayat MD, Internal Medicine Resident, Cecilia Fumberg MD
Background:
Sepsis is a hyper-inflammatory systemic reaction to infection. Early identification of infection and prompt treatment will decrease mortality in patients. Biomarkers to diagnose sepsis may allow early recognition and intervention. No single biomarker of sepsis is ideal, but many are helpful in terms of identifying critically ill patients who need more vigilant monitoring. Biomarkers such as TNF, IL-1β and IL-6, C-reactive protein (CRP), and procalcitonin may be of value in identifying sepsis.
Objective:
To evaluate the impact of the use of procalcitonin as a diagnostic biomarker for sepsis. Procalcitonin algorithms to guide the early identification of sepsis and the initiation of antibiotics for patients who present with bacterial infections.
Methods:
The study design was a single-center retrospective chart review. Inclusion criteria: patients admitted to 1 West, 2 North, 2 South, 3 South, and SDU from May 22, 2022-October 19, 2022 with at least one procalcitonin value equal to or less than 0.5. Exclusion criteria: Admitted to any service other than teaching or hospitalist, patients downgraded or upgraded from ICU, concomitant infection, non-relevant diagnosis, and error reports.
Results:
A total of 348 patients and 198 cases. The study analyzes the relationship between the severity of pneumonia and procalcitonin levels and assesses the rate of procalcitonin re-check. Adverse outcomes were similar in control trials and control groups. The duration of antibiotic use was lower and antibiotic-associated adverse effects were also lower.
Conclusion:
Procalcitonin is a helpful biomarker in the identification of infection in critically ill patients and limiting antibiotic use, but is not recommended as a single definitive test in the diagnosis of sepsis. Procalcitonin should not be seen as a binary “positive” or “negative.” ATS does not recommend the use of procalcitonin as a marker for antibiotic use. Take into account fevers, leukocytosis, tachypnea, tachycardia, lactic acidosis, hypotension, end-organ damage, altered mental status, etc.