Abstract
Procalcitonin (PCT) may be useful for early risk stratification in the emergency department (ED), but the transposition of published data to routine emergency practice is sometimes limited. An observational retrospective study was conducted in the adult ED of the Reims University Hospital (France). Over one year, 852 patients suspected of infection were included, of mean age 61.7 years (SD: 22.6), and 624 (73.2%) were hospitalized following ED visit. Overall, 82 (9.6%) patients died during their hospitalization with an odds ratio (OR) of 5.10 (95% CI: 2.19–11.87) for PCT ≥ 0.5, in multivariate logistic regression analyses. Moreover, 78 (9.2%) patients were admitted to an ICU, 74 (8.7%) had attributable bacteremia, and 56 (6.6%) evolved toward septic shock with an OR of 4.37 (2.08–9.16), 6.38 (2.67–15.24), and 6.38 (2.41–16.86), respectively, for PCT ≥ 0.5. The highest discriminatory values were found for patients with age <65 years, but PCT lost its discrimination power for in-hospital mortality in patients with a bronchopulmonary infection site or a temperature ≥37.8°C and for ICU admission in patients with severe clinical presentations. PCT could be helpful in risk stratification, but several limitations must be considered, including being sometimes outperformed by a simple clinical examination.
Highlights
Pierre Leroux, Sébastien de Ruffi, Laurent Ramont, Marion Gornet, Guillaume Giordano Orsini, et al
82 (9.6%) patients died during their hospitalization with an odds ratio (OR) of 5.10 for PCT ≥ 0.5, in multivariate logistic regression analyses
78 (9.2%) patients were admitted to an intensive care unit (ICU), 74 (8.7%) had attributable bacteremia, and 56 (6.6%) evolved toward septic shock with an OR of 4.37 (2.08–9.16), 6.38 (2.67–15.24), and 6.38 (2.41–16.86), respectively, for PCT ≥ 0.5. e highest discriminatory values were found for patients with age
Summary
Procalcitonin (PCT) may be useful for early risk stratification in the emergency department (ED), but the transposition of published data to routine emergency practice is sometimes limited. Transposition of certain published studies to routine emergency practice can be limited, because the studies evaluated the interest of PCT with complete disconnection from the clinical presentation (including uninfected patients), [6,7,8] or focused on selected infected patients (e.g., patients with a particular infection site or infection type or infection severity level), [9,10,11,12] or targeted every infected patient regardless of the medical reasoning [13, 14]. Numerous studies are issued from the same research teams, and some authors disclosed significant conflicts of interest (e.g., with laboratory manufacturing)
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