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Practice Patterns and Outcomes Associated with Procalcitonin Use in Critically Ill Patients with Sepsis.
Clin Infect Dis. 2017 Feb 24;:
Authors: Chu DC, Mehta AB, Walkey AJ
Abstract
Background: Randomized trials support use of procalcitonin-based algorithms to decrease duration of antibiotics for critically ill patients with sepsis. However, current utilization of procalcitonin and associated outcomes in "real world" clinical settings is unclear. We sought to determine procalcitonin utilization in critically ill patients with sepsis in the United States and to examine associations between procalcitonin use and clinical outcomes.
Methods: Retrospective cohort study of approximately 20% of patients hospitalized in US Intensive Care Units with sepsis. Hierarchical regression models were used to determine associations of procalcitonin use with outcomes (antibiotic-days, incidence of Clostridium difficile infection, and in-hospital mortality). Sensitivity analyses were conducted to assess robustness of findings to different methods used to address unmeasured confounding (e.g., instrumental variable, difference-in-differences analyses).
Results: Among 20,750 critically ill patients with sepsis in 107 hospitals with procalcitonin available, 3769 (18%) patients had procalcitonin levels checked; 1119 (29.7%) had serial procalcitonin measurements. Procalcitonin utilization was associated with increased antibiotic-days (adjusted RR 1.17, 95% CI 1.15-1.18) and incidence of Clostridium difficile (adjusted OR 1.42, 95% CI 1.09-1.85) without a change in mortality (adjusted HR 1.05, 95% CI 0.93-1.19). Analysis of procalcitonin utilization using instrumental variable and difference-in difference analyses showed similar lack of antibiotic or outcome improvements associated with procalcitonin use.
Conclusions: Use of procalcitonin was not associated with improved antibiotic utilization or other clinical outcomes in real-world settings. Programs to improve implementation of procalcitonin-based strategies are warranted prior to widespread adoption.
PMID: 28329238 [PubMed - as supplied by publisher]