Procalcitonin (PCT) testing on the first day of ICU admission for adult patients with sepsis is associated with reduced length of stay, less antibiotic exposure, and reduced hospital and pharmacy costs, Robert A. Balk, MD, and his associates reported.
The researchers analyzed data on more than 15 million patients in the Premier Research Database; of those, more than 730,000 had a potential diagnosis of sepsis, systemic inflammatory response syndrome (SIRS), septicemia, or a shock-related diagnosis on ICU admission or discharge (CHEST. 2017;151:23-33).
After propensity matching to reduce potential bias, a total of 33,569 patients who had received PCT testing on ICU day 1 were identified; a control group of 98,543 non-PCT tested patients were identified as well. Hospital costs were $2,759 lower for PCT-tested patients ($30,454 vs. $33,213), ICU costs were $1,310 lower ($20,155 vs. $21,465), and pharmacy costs were $331 lower ($4,238 vs. $4,568). PCT-tested patients also were more commonly discharged to home (44.1% vs. 41.3%).
The PCT-tested patients had less total antibiotic exposure, (16.2 days vs. 16.9 days) but higher laboratory costs, according to Dr. Balk, director of the division of pulmonary and critical care medicine at Rush Medical College, Chicago, and his colleagues. Laboratory costs of the PCT-tested patients were $81 greater ($1,807 vs. $1,726).
While PCT testing is cleared by the Food and Drug Administration to assist in identifying patients who are highly likely to develop sepsis, there is no approved sepsis test, Dr. Balk and his colleagues noted.
“This study is important in the validation of the ability of PCT testing to favorably impact the outcome of critically ill patients when used according to the FDA cleared guidelines,” the investigators said. “The cost savings were real and consequential, exceeding the potential increased costs of laboratory testing associated with PCT testing on ICU admission.”
All-patient analysis showed a statistically significant, but slightly increased (0.7%) risk of mortality in PCT-tested patients; however, the finding was not seen in an enhanced risk-adjusted analysis of 96% of patients, the investigators pointed out. This finding is consistent with other large prospective studies showing no difference in mortality or other clinical outcomes using PCT guidances.
PCT testing has not been uniformly adopted despite its inclusion in the 2012 Surviving Sepsis Guidelines, in part, due to cost. The lack of a “gold standard” sepsis test has resulted in diagnostic dilemmas, delayed treatment, and poor outcomes, Dr. Balk and colleagues noted.
Because patients were not randomized to PCT testing or non-PCT testing groups, additional variables could have over- or underestimated the effect of PCT on patient outcomes, the researchers added.
Dr. Balk has received advisory board fees from bioMerieux USA, Roche Diagnostics, and ThermoFisher Scientific; Zhun Cao, PhD, Craig Lipkin, MS, and Scott B. Robinson MA, MPH, are employees of Premier Research Services, in Charlotte. Samuel Bozzette is an employee of bioMerieux, which provided funding for the study.