The Role of Early Procalcitonin Determination in the Emergency Departiment in Adults Hospitalized with Fever

Marcello Covino,Veronica Ojetti,Francesco Franceschi,Giuseppe De Matteis,Maria Livia Burzo,Antonella Gallo,Benedetta Simeoni,Rita Murri,Marcello Candelli,Massimo Montalto

doi:10.3390/medicina57020179

Abstract

Background and Objectives: Fever is one of the most common presenting complaints in the Emergency Department (ED). The role of serum procalcitonin (PCT) determination in the ED evaluation of adults presenting with fever is still debated. The aim of this study was to evaluate if, in adults presenting to the ED with fever and then hospitalized, the early PCT determination could improve prognosis. Materials and Methods. This is a retrospective, mono-centric study, conducted over a 10-year period (2009–2018). We analyzed consecutive patients ≥18 years admitted to ED with fever and then hospitalized. According to quick sequential organ failure assessment (qSOFA) at admission, we compared patients that had a PCT determination vs. controls. Primary endpoint was overall in-hospital mortality; secondary endpoints were in-hospital length of stay, and mortality in patients with bloodstream infection and acute respiratory infections. Results. The sample included 12,062 patients, median age was 71 years and 55.1% were men. In patients with qSOFA ≥ 2 overall mortality was significantly lower if they had a PCT-guided management in ED, (20.5% vs. 26.5%; p = 0.046). In the qSOFA < 2 group the mortality was not significantly different in PCT patients, except for those with a final diagnosis of bloodstream infection. Conclusions. Among adults hospitalized with fever, the PCT evaluation at ED admission was not associated with better outcomes, with the possible exception of patients affected by bloodstream infections. However, in febrile patients presenting to the ED with qSOFA ≥ 2, the early PCT evaluation could improve the overall in-hospital survival.

Highlights

Fever is one of the most common cause of Emergency Department (ED) access, accounting for 5% up to 15% of adult visits [1]
An early antimicrobial administration demonstrated to be associated with reduced mortality in patients with bacterial infection and sepsis [1], the identification of fever of bacterial origin is essential for clinicians
For each patient included in the analysis, we evaluated vital signs and clinical symptoms to assess the quick Sepsis Related Organ Failure Assessment score [13] at ED admission

Summary

Introduction

Fever is one of the most common cause of Emergency Department (ED) access, accounting for 5% up to 15% of adult visits [1] It represents an early warning sign of most infections, but could be present in several non-infectious diseases, such as autoimmune diseases, and neoplasms [1]. The aim of this study was to evaluate if, in adults presenting to the ED with fever and hospitalized, the early PCT determination could improve prognosis. Among adults hospitalized with fever, the PCT evaluation at ED admission was not associated with better outcomes, with the possible exception of patients affected by bloodstream infections. In febrile patients presenting to the ED with qSOFA ≥ 2, the early PCT evaluation could improve the overall in-hospital survival

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Discussion

Conclusion