dangerous and often deadly condition, sepsis affects more than a million
Americans every year and the cases continue to increase. Each year, over $20 billion dollars is spent on sepsis care, making
it the most expensive condition managed in United States hospitals.
A new study in
the January issue of CHEST
examines whether procalcitonin
(PCT) testing helps to more effectively manage sepsis care.
Investigators found that the use of PCT screening on the first day of
ICU admission was linked to significantly shorter hospital stays, as
well as an overall decrease in cost of care.
‘The use of procalcitonin (PCT) testing on the first day of ICU care was associated with significantly lower hospital and ICU length of stay.’
Currently, there is not an accepted "gold standard" test for
determining whether a patient has sepsis, so the disease presents a
diagnostic challenge for practitioners. An incorrect sepsis diagnosis
can result in poor patient outcomes linked to the unnecessary use of
antibiotics, including increased length of hospital stay, Clostridium
difficile infections, and higher than necessary health care costs. In an
effort to find novel approaches to diagnosing sepsis, PCT screening has
recently gained momentum as a viable screening tool. PCT is a precursor
"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," explained
lead investigator Robert A. Balk, J. Bailey Carter, Professor of
Medicine, and Director of the Division of Pulmonary and Critical Care
Medicine, Rush Medical College and Rush University Medical Center,
"This study demonstrated that the use of PCT testing on the
first day of ICU care was associated with significantly lower hospital
and ICU length of stay. There was also a significant difference in the
total hospital, ICU and pharmacy costs when day one PCT testing was used
in adult critically ill patients."
The retrospective study examined 15,041,827 patient cases from the
Premier Healthcare database, of whom 730,088 had a potential sepsis,
SIRS, septicemia, or shock-related diagnosis on admission or discharge.
All patients included in the study were 18 years of age or older and
admitted to the ICU. Patients were divided into two groups by whether
they had received PCT screening on their first day in the ICU or not.
Investigators discovered that PCT-guided care on day one was associated
with a multitude of positive outcomes including significantly shorter
hospital and ICU stays and significantly decreased total hospital, room
and board, pharmacy, and antibiotic costs. Despite a slight increase in
laboratory costs, they also found that among the PCT patients,
antibiotic exposure was lower and they were less likely to be
transferred to acute care, skilled nursing, intermediate care, or
long-term care facilities.
In fact, the study revealed that patients receiving PCT testing on
day one of ICU admission averaged 1.2 fewer hospital days than patients
who were not screened and saved an average of $2,759 on their total
"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 FDA cleared guideline," said Dr. Balk. "The study
population was quite large and extremely diverse. The use of
procalcitonin was evaluated over nearly a 3.5-year period and in a
variety of clinical settings including academic and nonacademic
institutions. The cost savings were real and consequential, exceeding
the potential increased costs of laboratory testing associated with PCT
testing on ICU admission."
According to this new analysis, PCT screening on the first day of
ICU admission seems to be a promising diagnostic tool to help shorten
hospital stays, as well as helping to make sepsis treatment more
cost-effective. Early identification of sepsis patients can also help
combat negative outcomes since proper treatment techniques can be
implemented as soon as a diagnosis is made.
"The significance and mechanisms surrounding the observed clinical outcomes warrant additional evaluation," concluded Dr. Balk.