News: Procalcitonin-guided sepsis care improves short-term mortality, study finds

The incorporation of procalcitonin into an algorithm for sepsis diagnosis in the emergency department did not affect the timeliness of patients receiving IV antibiotics, a recent randomized PRONTO study found. However, it did reduce short-term mortality rates.

From November 2020 to November 2023, Stacy Todd, PhD, of Liverpool University Hospitals NHS Foundation Trust in England, along with colleagues, enrolled 7,667 patients ages 16 and older who presented to any of the 20 emergency departments across England and Wales with suspected sepsis.

Patients were excluded if they were receiving end-of-life care or immunosuppressive chemotherapy, and those undergoing transplant or urgent surgical intervention. The final primary analysis included 2,738 patients assigned to care guided by an algorithm incorporating procalcitonin labs, through clinicians could use or ignore those results.

Out of more than 5,000 patients, 48.6% of those receiving procalcitonin-guided care were given IV antibiotics at three hours versus 48.2% of those receiving usual care. Twenty-eight-day mortality was found to be significantly lower in the intervention group.

Procalcitonin-guided care results were considered in the clinical decision-making in 64.7% of cases, and the clinicians agreed with the algorithm’s recommendation in 47.2% of cases. Among 1,944 cases initially classified as high risk, consideration of procalcitonin labs reclassified 24.6% as low risk and 33% as medium risk.

Mortality was lower at 90 days in the procalcitonin-guided care group compared to the usual care group. No other statistically significant treatment effects on other secondary outcomes were identified, including days on antibiotic treatment.

Procalcitonin has been well-established as a biomarker that rapidly responds to bacterial infection with high specificity. Previous trials assessing its utility in diagnostic algorithms for sepsis, however, have been too heterogeneous or inadequately rigorous.

The researchers are planning additional research to understand the mechanisms behind this mortality reduction, "accepting that this will be vital for clinicians to have confidence in any intervention such as this to be able to be implemented in patient care,” said Todd.

“Making a procalcitonin-guided algorithm available to clinicians in emergency departments did not change intravenous antibiotic initiation at 3 h in patients managed as suspected sepsis, but a decrease in 28-day mortality was seen and further research is needed to understand this finding,” the researchers wrote.

Editor’s note: To read the full study, click here. To read additional coverage from MedPage Today, click here.