Highlights
- •The utility of a PCT guided management for respiratory tract infections in ED is still uncertain.
- •In general CAP patients the impact of an early PCT determination in ED was limited.
- •Patients with bloodstream infection could have reduced hospital stay if PCT is obtained in ED
- •Patients ≥ 85 years are more likely to have benefit from PCT determination.
- •PCT might be associated with reduced mortality in patients with severe CAP or high comorbidity
Abstract
We evaluated patients admitted through our ED for community-acquired pneumonia (CAP)
to assess the relevance of an early procalcitonin (PCT) determination on patient's
outcomes.
Methods
We reviewed all patients admitted for CAP in a 10 years period (2008-2017). Patients
were stratified according to age groups: (18-65 years; 65–84 years; and ≥85 years),
CURB-65 score, need for ventilation, Sepsis-3 criteria at admission, enrollment period,
blood culture in ED. In-hospital mortality rate and length of hospital stay (LOS)
were compared between patients that had an early PCT determination in ED vs. patients
admitted without.
Results
Our study cohort consisted of 4056 CAP patients, age 76 [IQ range 64-84] years. We
enrolled 1039 patients <65 years old, 2015 aged 65-84 years, and 1002 aged ≥85 years.
Overall, the early PCT determination in ED was not associated to a reduced LOS (p=0.630), nor to a reduced mortality rate (p=0.134). However, in patients ≥ 85 years,
the PCT determination in ED was associated with lower mortality in those with CURB-65
≥ 2, and Charlson's score ≥ 2 (p=0.033 and p=0.002, respectively).
Conclusions
Although an early PCT assessment in ED was not associated with better outcomes in
term of LOS and mortality in patients with CAP, our findings suggest that it might
be associated with reduced mortality in patients ≥ 85 years with severe CAP or high
comorbidity.
Keywords
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Article info
Publication history
Published online: May 12, 2020
Accepted:
April 27,
2020
Received in revised form:
March 11,
2020
Received:
September 21,
2019
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
