Key result
Early procalcitonin determination in the emergency department for patients with intra-abdominal infection showed no significant difference in intra-hospital mortality after propensity score matching.
Why the study?
Procalcitonin has been suggested to assist in defining infection status and individualizing therapy, but the effects on patient outcomes of early procalcitonin assessment in the emergency department for intra-abdominal infections remained unclear.
Does early procalcitonin assessment reduce intra-hospital mortality in patients with intra-abdominal infection in the emergency department?
Cohort (n=3,429)
No
Does early procalcitonin assessment reduce intra-hospital mortality in patients with intra-abdominal infection in the emergency department?
Early procalcitonin assessment in the emergency department for intra-abdominal infections does not improve in-hospital mortality and may slightly increase length of stay.
Early ED PCT assessment in IAI may aid individualized therapy; leaves open its prognostic value pending prospective validation.
Background: Intra-abdominal infection (IAI) is a wide range of intra-abdominal disease. Management involves empirical therapy and source control. Procalcitonin (PCT) has been suggested to assist in defining individual infection status and delivering individualized therapy. The aim of this study was to investigate the effects on patient outcomes of an early procalcitonin (PCT) assessment (in the emergency department [ED]) in patients with IAI. Methods: This was a retrospective, mono-centric study evaluating consecutive patients admitted to the ED from 2015 to 2019 with diagnosis of IAI. According to whether there had been PCT determination in the ED, patients were divided into no ePCT determination (no-ePCT) and early PCT determination in the ED (ePCT). The primary endpoint was the intra-hospital mortality rate. Secondary endpoints were occurrence of major complications and length of hospital stay (LOS). The propensity score match (PSM) was generated using a logistic regression model on the baseline covariates considered to be potentially influencing the decision to determine PCT in the ED and confounding factors identified as significant at a preliminary statistical analysis with respect to in-hospital death. Results: A series of 3,429 patients were included. The ePCT group consisted to 768 (22.4%), whereas the no-ePCT group contained 2,661 patients (77.6%). When the PSM was matched to the two groups, no significant difference was observed. Considering patients with uncomplicated infections, the PCT determination was associated with a higher mortality rate. We found no significant differences regarding outcomes with the exception of LOS, which was slightly longer in the ePCT group. However, we observed a tendency toward a minor difference in the number of complications in the ePCT group, in particular a reduced rate of progression to sepsis. Conclusion: Early PCT determination could be irrelevant in IAIs. The PCT value may be cost-effective and possibly improve the prognosis in cIAIs. Further research is needed to understand the optimal use of PCT, including in combination with other emerging diagnostic tests.
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Covino et al. (2021) conducted a cohort in Intra-abdominal infection (IAI) (n=3,429). Early procalcitonin (PCT) assessment vs. No early PCT determination was evaluated on Intra-hospital mortality rate. Early procalcitonin determination in the emergency department for patients with intra-abdominal infection showed no significant difference in intra-hospital mortality after propensity score matching.
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