The Role of Early Procalcitonin Determination in the Emergency Department in Adults Hospitalized with Fever
<i>Background and Objectives:</i> Fever is one of the most common presenting complaints in the Emergency Department (ED). The role of serum procalcitonin (PCT) determination in the ED evaluation of adults presenting with fever is still debated. The aim of this study was to evaluate if, i...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-02-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1010-660X/57/2/179 |
| _version_ | 1797721529103941632 |
|---|---|
| author | Marcello Covino Antonella Gallo Massimo Montalto Giuseppe De Matteis Maria Livia Burzo Benedetta Simeoni Rita Murri Marcello Candelli Veronica Ojetti Francesco Franceschi |
| author_facet | Marcello Covino Antonella Gallo Massimo Montalto Giuseppe De Matteis Maria Livia Burzo Benedetta Simeoni Rita Murri Marcello Candelli Veronica Ojetti Francesco Franceschi |
| author_sort | Marcello Covino |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Fever is one of the most common presenting complaints in the Emergency Department (ED). The role of serum procalcitonin (PCT) determination in the ED evaluation of adults presenting with fever is still debated. The aim of this study was to evaluate if, in adults presenting to the ED with fever and then hospitalized, the early PCT determination could improve prognosis. <i>Materials and Methods.</i> This is a retrospective, mono-centric study, conducted over a 10-year period (2009–2018). We analyzed consecutive patients ≥18 years admitted to ED with fever and then hospitalized. According to quick sequential organ failure assessment (qSOFA) at admission, we compared patients that had a PCT determination vs. controls. Primary endpoint was overall in-hospital mortality; secondary endpoints were in-hospital length of stay, and mortality in patients with bloodstream infection and acute respiratory infections. <i>Results.</i> The sample included 12,062 patients, median age was 71 years and 55.1% were men. In patients with qSOFA ≥ 2 overall mortality was significantly lower if they had a PCT-guided management in ED, (20.5% vs. 26.5%; <i>p</i> = 0.046). In the qSOFA < 2 group the mortality was not significantly different in PCT patients, except for those with a final diagnosis of bloodstream infection. <i>Conclusions.</i> Among adults hospitalized with fever, the PCT evaluation at ED admission was not associated with better outcomes, with the possible exception of patients affected by bloodstream infections. However, in febrile patients presenting to the ED with qSOFA ≥ 2, the early PCT evaluation could improve the overall in-hospital survival. |
| first_indexed | 2024-03-12T09:35:31Z |
| format | Article |
| id | doaj.art-d9875d0f74e74b78b4ee28ed07d6aa24 |
| institution | Directory Open Access Journal |
| issn | 1010-660X |
| language | English |
| last_indexed | 2024-03-12T09:35:31Z |
| publishDate | 2021-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-d9875d0f74e74b78b4ee28ed07d6aa242023-09-02T13:46:06ZengMDPI AGMedicina1010-660X2021-02-015717917910.3390/medicina57020179The Role of Early Procalcitonin Determination in the Emergency Department in Adults Hospitalized with FeverMarcello Covino0Antonella Gallo1Massimo Montalto2Giuseppe De Matteis3Maria Livia Burzo4Benedetta Simeoni5Rita Murri6Marcello Candelli7Veronica Ojetti8Francesco Franceschi9Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCSS, 00168 Rome, ItalyDepartment of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCSS, 00168 Rome, ItalyFaculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyDepartment of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCSS, 00168 Rome, ItalyEmergency Department, Ospedale Generale M.G. Vannini, Istituto Figlie di San Camillo, 00177 Rome, ItalyEmergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCSS, 00168 Rome, ItalyFaculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, ItalyEmergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCSS, 00168 Rome, ItalyEmergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCSS, 00168 Rome, ItalyEmergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCSS, 00168 Rome, Italy<i>Background and Objectives:</i> Fever is one of the most common presenting complaints in the Emergency Department (ED). The role of serum procalcitonin (PCT) determination in the ED evaluation of adults presenting with fever is still debated. The aim of this study was to evaluate if, in adults presenting to the ED with fever and then hospitalized, the early PCT determination could improve prognosis. <i>Materials and Methods.</i> This is a retrospective, mono-centric study, conducted over a 10-year period (2009–2018). We analyzed consecutive patients ≥18 years admitted to ED with fever and then hospitalized. According to quick sequential organ failure assessment (qSOFA) at admission, we compared patients that had a PCT determination vs. controls. Primary endpoint was overall in-hospital mortality; secondary endpoints were in-hospital length of stay, and mortality in patients with bloodstream infection and acute respiratory infections. <i>Results.</i> The sample included 12,062 patients, median age was 71 years and 55.1% were men. In patients with qSOFA ≥ 2 overall mortality was significantly lower if they had a PCT-guided management in ED, (20.5% vs. 26.5%; <i>p</i> = 0.046). In the qSOFA < 2 group the mortality was not significantly different in PCT patients, except for those with a final diagnosis of bloodstream infection. <i>Conclusions.</i> Among adults hospitalized with fever, the PCT evaluation at ED admission was not associated with better outcomes, with the possible exception of patients affected by bloodstream infections. However, in febrile patients presenting to the ED with qSOFA ≥ 2, the early PCT evaluation could improve the overall in-hospital survival.https://www.mdpi.com/1010-660X/57/2/179procalcitoninemergency departmentqSOFAsepsisfever |
| spellingShingle | Marcello Covino Antonella Gallo Massimo Montalto Giuseppe De Matteis Maria Livia Burzo Benedetta Simeoni Rita Murri Marcello Candelli Veronica Ojetti Francesco Franceschi The Role of Early Procalcitonin Determination in the Emergency Department in Adults Hospitalized with Fever Medicina procalcitonin emergency department qSOFA sepsis fever |
| title | The Role of Early Procalcitonin Determination in the Emergency Department in Adults Hospitalized with Fever |
| title_full | The Role of Early Procalcitonin Determination in the Emergency Department in Adults Hospitalized with Fever |
| title_fullStr | The Role of Early Procalcitonin Determination in the Emergency Department in Adults Hospitalized with Fever |
| title_full_unstemmed | The Role of Early Procalcitonin Determination in the Emergency Department in Adults Hospitalized with Fever |
| title_short | The Role of Early Procalcitonin Determination in the Emergency Department in Adults Hospitalized with Fever |
| title_sort | role of early procalcitonin determination in the emergency department in adults hospitalized with fever |
| topic | procalcitonin emergency department qSOFA sepsis fever |
| url | https://www.mdpi.com/1010-660X/57/2/179 |
| work_keys_str_mv | AT marcellocovino theroleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT antonellagallo theroleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT massimomontalto theroleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT giuseppedematteis theroleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT marialiviaburzo theroleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT benedettasimeoni theroleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT ritamurri theroleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT marcellocandelli theroleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT veronicaojetti theroleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT francescofranceschi theroleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT marcellocovino roleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT antonellagallo roleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT massimomontalto roleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT giuseppedematteis roleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT marialiviaburzo roleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT benedettasimeoni roleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT ritamurri roleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT marcellocandelli roleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT veronicaojetti roleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever AT francescofranceschi roleofearlyprocalcitonindeterminationintheemergencydepartmentinadultshospitalizedwithfever |