Procalcitonin (PCT) Level in the Emergency Department Identifies a High-Risk Cohort for All Patients Treated for Possible Sepsis

WHAT IS ALREADY KNOWN? 1. The benefits of measuring PCT in the Emergency Department (ED) are not yet fully characterised. 2. PCT is widely used in the intensive care setting to guide antimicrobial prescribing. WHAT THIS ADDS? Measurement of PCT as a routine in the emergency department for all patients treated for possible sepsis identifies a high-risk cohort. KEY IMPROVEMENT IN PATIENT CARE: 1. A PCT measurement of >0.2ug/L in the Emergency Department identifies a patient at increased risk of deterioration and of in-hospital death. BACKGROUND: Early recognition and management of sepsis in the Emergency Department (ED) is a clinical challenge. Our aim was to determine if measuring the biomarker PCT in patients with suspected sepsis enables the identification of patients at increased risk of deterioration or in-hospital death in the ED setting of a district general hospital in the United Kingdom. METHODS: A prospective observational study was conducted on all patients aged 18 and over presenting to ED fulfilling NICE criteria for moderate to high risk of sepsis admitted to hospital. Patients had a PCT test alongside the sepsis six protocol. PCT was measured using Brahms’s chemiluminescent micro particle assay (CMIA) for the quantitative determination of PCT in human serum and plasma on the Abbott Alinity I analytical platform. The cost per test was approximately 13 GBP. The analysis was performed on patients having a PCT in ED over a 7-month period, with in-depth scrutiny of an appropriate subgroup. A high level quality improvement (QI) approach was used in the study. RESULTS: A total of 1242 patients were included in the study. Mean/median age was 67.9/72, (range 18-102). 88.7% of deaths occurred in patients over 65 years of age. 42.4% (n=532) had a PCT level in ED of >0.2 ug/L. This identified a high risk group with a 2.4 fold increase in mortality rate (7.7%:18.2% p value <0.001). The median length of stay (LOS) was 5 (IQR 9) and 8 days (IQR 11) in patients with a first PCT of ≤0.2 ug/L versus >0.2 ug/L respectively. CONCLUSION: An immediate PCT on patients presenting to ED with signs of sepsis in a non-specialised acute trust identifies those patients at an increased risk of deterioration and in hospital death.