Procalcitonin (PCT) testing on the first day of intensive care unit (ICU) admission in patients with suspected sepsis was associated with significantly lower hospital and ICU lengths of stay, as well as reduced total, ICU, and pharmacy cost of care (Chest 2017;151:23–33).
“Despite the emergence of PCT as a diagnostic criterion for sepsis in the 2012 Surviving Sepsis Guidelines, PCT testing has not been uniformly adopted, in part because of cost considerations,” said lead investigator Robert A. Balk, MD, professor of medicine at Rush Medical College in Chicago, in a statement. “This study is important because it validates the ability of PCT testing to favorably impact outcomes of critically ill patients when used according to the [Food and Drug Administration] cleared guideline.”
Balk and his colleagues accessed data from the Premier Healthcare database on 730,888 patients treated at 570 U.S. hospitals with suspected sepsis or related diagnoses. The researchers stratified patient data further by whether PCT levels were obtained within the first day of ICU admission or not. Next, they propensity-matched 33,569 patients who received first-day PCT testing with 98,543 who did not.
The authors found that patients with PCT testing had significantly lower mean total and ICU length of stay in comparison to those without (11.6 days versus 12.7 days and 5.1 days versus 5.3 days, respectively). Hospital costs also were lower for patients with PCT testing: mean cost $30,454 versus $33,213. In addition, patients with PCT testing had a mean 0.7 days less total antibiotic exposure than those without testing. Meanwhile, laboratory costs for PCT-tested patients were a mean $81 greater, perhaps due to the PCT testing, according to the authors.
The authors speculated that PCT was used to help rule-out and rule-in sepsis on ICU admission, which in the former would directly save resources and in the latter facilitate earlier, effective antibiotic administration.