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Procalcitonin testing associated with lower costs, lengths of stay for sepsis
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Procalcitonin testing for suspected sepsis patients on the first day of ICU care was associated with significantly reduced lengths of hospital stay and decreased costs for hospital care, study data show.
“Sepsis is increasingly common, and despite advances in antimicrobial and supportive therapy, continues to be associated with a high risk for morbidity and mortality,” Robert A. Balk, MD, of the division of pulmonary and critical care medicine at Rush University Medical Center, and colleagues wrote. “Lack of a ‘gold standard’ diagnostic test for sepsis has resulted in diagnostic dilemmas which may delay appropriate treatment and lead to poor outcomes. Unnecessary antibiotic use, a consequence of sepsis overdiagnosis, is associated with increased length of stay, drug-related toxicities, Clostridium difficile infection, antimicrobial resistance and health care costs.”
Balk and colleagues used the Premier Healthcare Database to identify 730,088 patients aged 18 years and older diagnosed with suspected or confirmed sepsis, systemic inflammatory response syndrome, septicemia or shock from January 2011 through May 2014. Patients were divided into two cohorts: those whose procalcitonin levels were obtained within 1 day of ICU admission (n = 34,989) and those whose levels were not (n = 671,473). Information on utilization, cost and patient outcomes were included in the database. After Balk and colleagues performed propensity matching, the cohorts were narrowed down to 98,543 non-procalcitonin–managed patients at 570 hospitals and 33,569 procalcitonin-managed patients at 286 hospitals.
Procalcitonin-managed patients spent a mean of 1.2 fewer days in the hospital compared with non-procalcitonin–managed patients (11.6 vs. 12.7; 95% CI, 1-1.3), the researchers reported. They also spent 0.2 fewer days in the ICU (5.1 vs. 5.2; 95% CI, 0.1-0.3), and had 0.7 fewer days of antibiotic exposure (16.2 vs. 16.9; 95% CI, 0.4-0.9).
The procalcitonin-managed cohort’s total hospital costs were $2,759 less (30,454 vs. 33,213; 95% CI, 2,156-3,321). The same cohort’s ICU costs were $1,310 less (20,155 vs. 21,465; 95% CI, 847-1,702). Those patients also were discharged home more commonly than nonmanaged patients (44.1% vs. 41.3%; 95% CI, 2.3-3.3), but had a 0.7% greater inpatient mortality (19% vs. 18.3%; 95% CI, 0.3-1.2). Laboratory costs were $81 more costly for procalcitonin-managed patients ($1,807 vs. $1,726; 95% CI, 51-114).
“Evaluation of adult patients from U.S. hospitals in the Premier Healthcare database suggests that use of procalcitonin testing on ICU admissions was associated with a significant decrease in hospital and ICU length of stay, less systemic antibiotic exposure, a slight increase in laboratory costs, and decreased hospital, ICU and pharmacy costs,” Balk and colleagues wrote. “The significance and mechanisms surrounding the observed clinical outcomes warrant additional evaluation.” – by Andy Polhamus
Disclosure: Balk reports receiving advisory board fees from bioMerieux USA, Roche Diagnostics and ThermoFisher Scientific, along with research support and speaking honoraria from bioMerieux. Please see the full study for a list of all other authors’ relevant financial disclosures.
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