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Peptide screening for sepsis cuts hospital stays and cost

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Measuring for a specific marker of sepsis risk when a patient is admitted to hospital can reduce their length of stay and total cost of healthcare, according to US researchers.

A new study published in the journal Chest examined whether testing levels of procalcitonin (PCT) – a peptide precursor of the hormone calcitonin – helped to more effectively manage sepsis care.

“It validates the ability of PCT testing to favourably impact outcomes of critically ill patients”

Robert Balk

Researchers found that testing levels on the first day of intensive care admission was linked to significantly shorter hospital stays, as well as an overall decrease in cost of care.

They noted that there was not currently an accepted “gold standard” test for determining whether a patient had sepsis, so the condition presented a diagnostic challenge for practitioners.

An incorrect sepsis diagnosis could result in poor patient outcomes linked to the unnecessary use of antibiotics, including increased length of hospital stay, and Clostridium difficile infections, they said.

The researchers, from the Rush University Medical Center in Chicago, highlighted that procalcitonin screening had recently “emerged” as a potential screening tool but had not been widely adopted due to “cost-considerations”.

They retrospectively examined 730,088 cases of potential sepsis, systemic inflammatory response syndrome, septicaemia, or shock-related diagnosis on admission or discharge.

All study participants were 18 years of age or older and admitted to ICU. Patients were divided into two groups, depending on whether they received PCT screening on their first day in ICU or not.

The researchers found that PCT-guided care on day one was associated with a range of positive outcomes, including significantly shorter hospital and ICU stays and significantly decreased total hospital and pharmacy costs.

Despite a slight increase in laboratory costs among the PCT patients, they also found antibiotic exposure was lower and they were less likely to be transferred to acute care, specialist nursing, intermediate care, or long-term care facilities.

Overall, the study authors revealed that patients receiving PCT testing on day one of ICU admission averaged 1.2 fewer hospital days than patients who were not screened.

Lead author Professor Robert Balk said: “PCT testing has not been uniformly adopted, in part because of cost considerations.

Rush University Medical Center

Peptide screening for sepsis cuts hospital stays and cost

Robert Balk

“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,” he said. “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.”

He added: “This study is important because it validates the ability of PCT testing to favourably impact outcomes of critically ill patients.

Professor Balk noted that the study population was “quite large and extremely diverse”, and that use of procalcitonin was evaluated over nearly a 3.5-year period and in a variety of clinical settings.

“The cost savings were real and consequential, exceeding the potential increased costs of laboratory testing associated with PCT testing on ICU admission,” he said.

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