Diagnostic accuracy of procalcitonin compared with sepsis-2 and sepsis-3 criteria in emergency department
Keywords:
SIRS, qSOFA, Procalcitonin, Organ dysfunction, Emergency DepartmentAbstract
Objective : As procalcitonin (PCT) level is significantly correlated with sequential organ failure assessment (SOFA) in ICU setting, we postulate that PCT could be substituted for SOFA in assessing sepsis in an emergency department (ED). Therefore, this study aims to compare the validity of PCT with Sepsis-2 and Sepsis-3 for diagnosing sepsis.
Methods : This prospective observational study was conducted in the ED, at one tertiary care hospital, Thailand from June 2017 to September 2017. Inclusion were consecutive adults, aged 18 years and older, with presumed infection admitted to the ED. Vital signs and the Glasgow Coma Scale (GCS) at nurse triage had been collected to access quick SOFA (qSOFA) and systemic inflammatory response syndrome (SIRS), including blood test for procalcitonin (PCT) level. Sepsis was diagnosed by positive hemoculture result or end-organ dysfunction. The diagnostic efficiency has been analyzed in the context of the area under the receiver operating characteristic (AUROC), sensitivity and specificity. The connection between serum PCT, qSOFA and SOFA was evaluated by the correlation test.
Results : We had 207 patients enrolled to the study, 49.8% were diagnosed with sepsis. The diagnostic value of PCT was as accurate as qSOFA. (AUROC 0.73 (0.66-0.80) vs. AUROC 0.71 (0.65-0.77), p 0.742). Compared to SIRS, the diagnostic accuracy was significantly higher for PCT (AUROC 0.58 (0.50-0.65) vs 0.73 (0.66-0.80), p 0.001). There was a statistical correlation between SOFA and procalcitonin, on the contraly, no correlation was found between qSOFA and procalcitonin.
Conclusions : Diagnostic efficacy of serum PCT was equivalent to qSOFA, but there was no correlation between qSOFA and PCT, consequently serum PCT played a limitation role in an ED.
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