Procalcitonin is a biomarker that shows good specificity in identifying septic patients. The purpose of this study was to investigate the diagnostic accuracy of procalcitonin in a community hospital setting. Two comparative groups were analyzed using an exploratory descriptive case-control study with secondary analysis of retrospective data from a 19 month period when procalcitonin was implemented. Secondly, a retrospective quasi-experimental study was done using a control group of emergency department patients with a sepsis diagnosis. Data included 19 months prior to the implementation of procalcitonin. In the retrospective review of 165 sepsis cases, there was a positive correlation between lactic acid and procalcitonin values. Sensitivity for positive blood cultures was 89.7% for procalcitonin (>0.1 ng/mL) and 64.9% for lactic acid when lactic acid values were > 2 mmol/L. After implementation, there was a significant decrease in cost of hospitalization. Prior to procalcitonin implementation the median cost was $10,271 and post procalcitonin the median cost was $6,981. Neither the hospital nor ICU length of stay, demonstrated a difference pre and post implementation of procalcitonin. We established that procalcitonin had a higher sensitivity in our community hospital than lactic acid and therefore a higher predictive usefulness in determining those patients with positive blood cultures. Suggestions to improve the lactic acid sensitivity by decreasing the cutoff to 1.4 mmol/L resulted in a decrease in specificity and positive predictive value. The implementation of procalcitonin, resulted in a cost savings, but not from decreasing length of stay. This savings may be associated with a variable outside of the length of stay, or the non-parametric test was not powerful enough to a show a decrease in length of stay. As this is typically the greatest driver of cost, we will further review how the savings was realized and how we can better impact length of stay.
12th Annual BHSF Research Conference
Baptist Health South Florida Affiliations:
Nathalia De Oro, AS, MT, AAB
Maria Gauthreaux, MSHSA, BS, MT, ASCP
Joseph Scott, M.D, FACEP
Julie Lamoureux, DMD, MSc
De Oro, Nathalia; Gauthreaux, Maria; Scott, Joseph; and Lamoureux, Julie, "The Use of Procalcitonin as a Sepsis Marker in a Community Hospital" (2017). All Publications. 2100.
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