Association between change in serum procalcitonin and 28-day outcomes in patients with presumed bacterial sepsis

Abstract

Introduction: Sepsis remains a major cause of mortality worldwide despite the increase in deaths due to non-communicable diseases. Poor diagnostic capability and delay in confirming appropriateness of therapy are major contributors to these poor outcomes. Procalcitonin has emerged as a useful tool for diagnosis and prediction of clinical outcomes in patients with sepsis.

Materials and methods: The study was conducted as an observational cohort study at the Kenyatta National hospital. Patients with presumed bacterial sepsis were evaluated for procalcitonin levels on admission and 48 hours after initiation of treatment. Patients were allocated to the 2 study arms on the basis of the change in their procalcitonin levels over the initial 48 hours, with unexposed being those with a decline greater than 30% and exposed having a rise in procalcitonin levels or a decline of less than 30%. Outcomes were documented after a 28-day follow-up period.

Results: More patients (16.9%) died in the exposed than the unexposed study arm (7.4%); however, this difference was not statistically significant (p=0.075). Duration of hospital stay was longer in the exposed study arm (9 days vs 12) but this was also not statistically significant (p=0.077).

Conclusion: Procalcitonin kinetics may not be a useful predictor of clinical outcomes in non-ICU setting.