Summarizing an Online Article (PCT and QSOFA)

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432218/

J Clin Med. 2021 Sep; 10(17): 3869.

Published online 2021 Aug 28. doi: 10.3390/jcm10173869

PMCID: PMC8432218    PMID: 34501324

Diagnostic Performance of Procalcitonin for the Early Identification of Sepsis in Patients with Elevated qSOFA Score at Emergency Admission

Myrto Bolanaki, et al

Reader

- The article discusses the use of procalcitonin (PCT) as a biomarker for early identification of sepsis in emergency departments (EDs).
- The study aims to investigate the diagnostic performance of PCT for early identification of septic patients and patients likely to develop sepsis within 96 hours of admission to an ED among a prospectively selected patient population with elevated quick Sequential Organ Failure Assessment (qSOFA) score.
- The study included 742 adult patients with a qSOFA score of at least 1 who presented to the ED. PCT levels were measured upon admission.
- Of the study population, 27.3% (n=202) were diagnosed with sepsis within the first 96 hours.
- The area under the curve for PCT for the identification of septic patients in EDs was 0.86.
- The sensitivity for PCT at a cut-off of 0.5 µg/L was 63.4%, and the specificity was 89.2%.
- The positive predictive value was 68.8%, and the negative predictive value was 86.7%.
- The early measurement of PCT in a patient population with an elevated qSOFA score served as an effective tool for the early identification of sepsis in ED patients.
- Logistic regression analyses were performed for the primary endpoint as the dependent variable, with PCT as a binary variable at the aforementioned cut-off points.

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Summary

🩸 Procalcitonin (PCT) can help with early identification of sepsis in emergency departments (EDs) and could be beneficial as a point-of-care biomarker. 🩸 PCT was investigated as a potential diagnostic tool for sepsis in patients with elevated quick Sequential Organ Failure Assessment (qSOFA) scores upon admission to the ED. 🩸 In a multi-center prospective cohort study, PCT levels were measured upon admission in 742 adult patients with a qSOFA score of at least 1 who presented to the ED. 🩸 27.3% of the study population were diagnosed with sepsis within the first 96 hours. 🩸 The area under the curve for PCT for identifying septic patients in EDs was 0.86, with a sensitivity of 63.4% and a specificity of 89.2%. 🩸 The positive predictive value of PCT was 68.8%, and the negative predictive value was 86.7%. 🩸 The early measurement of PCT in a patient population with elevated qSOFA scores served as an effective tool for the early identification of sepsis in ED patients.

Facts

• Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to an infection, and early identification of septic patients and patients likely to develop sepsis is a top clinical priority to enable early strategy implementation.
• The qSOFA score consists of three easy-to-assess parameters, and a qSOFA score of 2 or higher should prompt physicians to look for evidence of organ dysfunction and to search for sepsis.
• Procalcitonin (PCT) is a biomarker that rises rapidly during an infection and has already been established to monitor response to and guide antimicrobial therapy in septic patients.
• The study included all adult patients (n = 742) with a qSOFA score of at least 1 who presented to the ED, and PCT levels were measured upon admission.
• 27.3% of the study population were diagnosed with sepsis within the first 96 hours.
• The area under the curve for PCT for identifying septic patients in EDs was 0.86, with a sensitivity of 63.4% and a specificity of 89.2%.
• The positive predictive value of PCT was 68.8%, and the negative predictive value was 86.7%.

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native abstract

Infectious biomarkers such as procalcitonin (PCT) can help overcome the lack of sensitivity of the quick Sequential Organ Failure Assessment (qSOFA) score for early identification of sepsis in emergency departments (EDs) and thus might be beneficial as point-of-care biomarkers in EDs. Our primary aim was to investigate the diagnostic performance of PCT for the early identification of septic patients and patients likely to develop sepsis within 96 h of admission to an ED among a prospectively selected patient population with elevated qSOFA score. In a large multi-centre prospective cohort study, we included all adult patients (n = 742) with a qSOFA score of at least 1 who presented to the ED. PCT levels were measured upon admission. Of the study population 27.3% (n = 202) were diagnosed with sepsis within the first 96 h. The area under the curve for PCT for the identification of septic patients in EDs was 0.86 (95% confidence interval (CI): 0.83–0.89). The resultant sensitivity for PCT at a cut-off of 0.5 µg/L was 63.4% (95% CI: 56.3–70.0). Furthermore, specificity was 89.2% (95% CI: 86.3–91.7), the positive predictive value was 68.8% (95% CI: 62.9–74.2), and the negative predictive value was 86.7% (95% CI: 84.4–88.7). The early measurement of PCT in a patient population with elevated qSOFA score served as an effective tool for the early identification of sepsis in ED patients