Utilizing Procalcitonin Levels as a Metric for Sepsis Treatment and its Effect on Length of Hospital Admission

Sepsis is the human body’s response to severe infection. It has been historically challenging to determine the cause of the diffuse inflammatory response associated with sepsis. Sepsis can arise from any region of the body but most cases evolve from the genitourinary, respiratory, gastrointestinal and epidermal systems.1 Mortality rates can range from 25-30% in cases of severe sepsis and can reach as high as 40-70% in cases of septic shock.1 In 2012, 5% of the total aggregate hospital utilizations were from sepsis treatment, causing it to become the most expensive condition treated in the U.S. at the hospital level. Much research has been undertaken to identify a more specific marker of sepsis severity in an effort to decrease the length of hospital admissions and the burden of cost to the U.S. Healthcare system. Procalcitonin (PCT) is a peptide precursor of the hormone calcitonin that was discovered in the 1970s and is now being utilized as a more specific marker of sepsis treatment as it does not drastically increase as an acute phase reactant from non-bacterial inflammatory conditions. The use of PCT as it relates to improved outcomes of sepsis with decreased hospital admission duration needs to be established. The purpose of this paper is to review published literature on studies that utilized PCT as a marker for sepsis outcomes, antibiotic stewardship, sepsis etiology and early hospital discharge. Publications more than five-years-old were excluded. Only studies utilizing PCT as part of a sepsis treatment algorithm in the hospital setting were included. PubMed, Ebsco, Cochrane library and Google Scholar were utilized as search engines. This review did not identify a statistically significant correlation between the utilization of PCT during the treatment of sepsis and a reduction in hospital mortality or length of stay. There was a correlation discovered between the use of this biomarker and a reduction in the duration of antibiotics in the treatment of sepsis. This literature review may aid clinicians in their antibiotic stewardship while treating sepsis but PCT cannot definitively be recommended as a metric for the early discharge of patients in the hospital setting. More research is required before making this recommendation