How fast can we find better ways to win the fight against sepsis? For hospitals, healthcare professionals and patients across the country, that answer can't come soon enough. More people die from sepsis than from prostate cancer, breast cancer and AIDS combined.1 It's also the No.1 financial burden for hospitals, with nearly $24 billion in aggregate costs every year.2
The diagnosis of sepsis can be a challenge due to its ambiguous signs and symptoms. Even after a definitive diagnosis of sepsis, treatment is a tightrope walk that involves fine-tuning the prescription of antibiotics so not too much, or too little, is administered.
PCT: A powerful ally delivers fresh insight
However, hospitals have found a highly effective ally as they combat this stealthy, stalwart syndrome. Procalcitonin (PCT) is a sensitive and specific biomarker associated with the inflammatory response to bacterial infection, and it can provide valuable insights when combined with clinical judgment.3
“Of the more than 175 biomarkers available to assess infection today, PCT is the only one that requires both bacterial toxins and an inflammatory response in order for levels to be elevated,” says the Director of Pharmacy and Laboratory Services at Five Rivers Medical Center Mike Broyles, PharmD.
Now, due to the recent FDA clearance of PCT on a fully automated and integrated platform from Roche Diagnostics, many more U.S. hospitals have started integrating PCT into their sepsis protocol. Here's a look at how three institutions have leveraged PCT to uncover critical, and previously invisible, sepsis insights.
Improving patient care in a busy emergency department
Across the UC San Diego Health system, the emergency departments see more than 130,000 patients annually.4 When PCT became available on the Roche platform, the Associate Clinical Professor of Emergency Medicine Sean-Xavier Neath, M.D., Ph.D., and the Professor of Pathology, Director of Toxicology and Associate Director of Clinical Chemistry Robert L. Fitzgerald, Ph.D., worked with a cross-disciplinary team to bring it to UC San Diego Health. The assay is still very new to the hospital, which started running it this past April, but already Dr. Neath sees its promise.
“The literature has shown the implications can be huge with regard to how long a patient stays in the hospital,” Dr. Neath says. “PCT provides a baseline of how sick a patient was when he or she came in, and from that, it can help inform treatment choices to ensure the best outcome.”
Reducing antibiotics and patient stays at a regional hospital
Meanwhile, the use of PCT is a well-established practice at Washington Regional Medical Center. The 425-bed facility, located in Fayetteville, Ark., implemented the use of PCT in October 2012. In 2013, a sepsis management program was instituted due to a higher-than-expected mortality rate. However, the mortality rate decreased dramatically once the sepsis management program using PCT was in place, dropping from about 29 percent in 2012 to roughly 11 percent in 2015.
In December 2016, the hospital switched its PCT testing to the Roche platform to take advantage of the labor-saving benefits of automation.
“In our institution, we have found that when we use PCT guidance for sepsis and antibiotic treatment decisions, we see that we're better stewards of antibiotics,” says Washington Regional's Infectious Disease Specialist and Antibiotic Stewardship Director James Newton, M.D. “What's more, it's an affordable test. If I can get a patient out of the ICU a day or two earlier, I'm saving a significant amount of money.”
Precise PCT testing enables cutting-edge medicine at hospitals of all sizes
For Dr. Broyles, providing the right treatment to the right patient for the right duration has always been a priority at Five Rivers Medical Center. So, when the PCT assay was first released about seven years ago, Dr. Broyles made sure it was brought on board at the 50-bed hospital, located in Pocahontas, Ark.
The hospital uses the assay as a measurement tool for bacterial load, and it has enabled clinicians to act much more quickly and proactively. In fact, introducing the PCT assay has worked so well for Five Rivers that a recent in-house study of 2,152 patients has revealed impressive results.
“We saw a 47.1 percent reduction in antimicrobial days of therapy, a 51.5 percent reduction in sepsis mortality and a 37.3 percent reduction in 30-day readmissions,” Dr. Broyles says. “PCT has absolutely made a significant difference in improving patient outcomes.”
PCT uncovers promising possibilities in the fight against sepsis
From crowded emergency departments in big cities to small community hospitals, clinicians and laboratorians alike are realizing the multiple benefits of implementing PCT as part of their sepsis protocols, from decreased mortality rates to shorter stays in ICU.
With its ability to detect and monitor the severity of bacterial infections and provide fast, reliable results, the newly approved Elecsys® BRAHMS PCT on Roche Diagnostics' automated platform offers new possibilities in winning the fight against sepsis.
To learn more, visit https://usinfo.roche.com/pct .
- Leading Causes of Death.” Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm (accessed May 12, 2017).
- Torio, Ph.D., M.P.H., Celeste M. and Brian J. Moore, Ph.D. “National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013.” Healthcare Cost and Utilization Project. Statistical Brief #204. May 2016. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.pdf (accessed May 12, 2017).
- “Clinical Update.” UC San Diego Emergency Medicine. Annual Newsletter, 2016/17. https://healthsciences.ucsd.edu/som/emergency-med/Documents/Newsletter%20ed2.pdf (accessed June 5, 2017).
Elecsys. BRAHMS PCT [package insert]. Indianapolis, IN: Roche Diagnostics; 2016.