SESSION TITLE: Biomarkers in Severe Sepsis and Septic Shock
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 28, 2015 at 02:45 PM - 04:15 PM
PURPOSE: Procalcitonin (PCT) is a marker of systemic inflammation. Levels during illness can reflect therapeutic response. PCT is known for distinguishing bacterial from viral etiology, and thereby helping to reduce antibiotic use. Our study will add to data regarding diagnostic and prognostic properties of PCT and will assess its association with clinical outcomes. Values in viral respiratory infections will be assessed to probe the validity of PCT in distinguishing bacterial from viral infections. The nature of extreme PCT elevation will be characterized.
METHODS: This is a retrospective cohort study of 3614 encounters representing 3077 patients admitted 1/1/13-1/31/14 with PCT measured in the first 48 hours of admission.These values were compared for categories of key covariates and categorized into five groups. The first group contained the lowest levels (PCT<0.05 ng/mL) The remaining values were grouped by quartiles. Appropriate statistical tests were used to compare the demographic and admission characteristics, laboratory results, and outcomes of groups. Respiratory viral panel (RVP) positive, RVP negative, and encounters without RVP were compared. In depth chart review of the top 2% of PCT values was completed.
RESULTS: Median age was 67 years and, 48% were female. Hospital mortality was 7% while 30 day mortality was 16%. Median PCT was 0.28 ng/mL. Age and gender were not associated with PCT values. Increasing PCT was significantly associated with increasing level of care, length of stay, and mortality. Renal and liver disease was more prevalent with increasing PCT. PCT was lowest in those with positive RVP assays, highest in not tested RVP groups, and intermediate with negative RVP. Subjects with higher PCT values had a greater prevalence of positive blood cultures. Higher PCT was associated with higher WBC and lower platelet counts. Patients with the top 2% of PCT values (n=72) had PCT values of 78 to 200 ng/mL. Hospital and 30 day mortality in this group was 19% and 26%, respectively. Only 3% of this group had a positive RVP. The majority of subjects had at least one positive culture (82%). Gram negative organisms were more common than gram positive (49% vs 21%).
CONCLUSIONS: Elevated PCT was associated with higher level of care, longer hospital stay, increased mortality, and bacterial infection. Those with respiratory viral infections had lower PCT. Extremely high PCT was mostly associated with gram negative organisms.
CLINICAL IMPLICATIONS: PCT is useful in diagnosis and prognosis of hospitalized patients.
DISCLOSURE: The following authors have nothing to disclose: Heather Baran, Amir Rezk, Ruby Kesar, Andrea Berger, Shravan Kethireddy, Jason Stamm
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