Utility of procalcitonin and C-reactive protein in the septic patient in the emergency department

Julián Jiménez A, Palomo De Los Reyes MJ, Ortiz Díaz-Miguel R, Pedrosa Guerrero A, Parejo Miguez R, Salcedo Martínez R

Objective: To analyze the utility of procalcitonin (PCT) and C-reactive protein (CRP) as

criteria for admission or discharge, or to indicate the need for immediate antimicrobial

treatment in the emergency department in patients with systemic inflammatory response

syndrome (SIRS), sepsis, or septic shock.

Materials and method: This was a prospective study with a duration of 14 months,

performed in adults with SIRS, sepsis, or septic shock. CRP (normal value, 0-8 mg/mL)

and PCT (normal value, 0.5 ng/mL) were requested in the emergency department. Records

were kept of the PCT and CRP values, microbiological samples collected and

their results, antibiotic administration, need for admission, and mortality.

Results: There were 300 patients with SIRS of noninfectious etiology, 100 with sepsis,

and 20 with septic shock. Significantly higher CRP and PCT values were found in sepsis

than in SIRS (P<.01 for both comparisons), and CRP values were higher in septic shock than in sepsis (P<.01). There was a nonsignificant trend towards a higher 30-day mortality rate in patients with sepsis and septic shock in whom intravenous fluids and antibiotic therapy were not started in the emergency room (27% mortality) compared with those in whom this treatment was started (22%). PCT levels over 2 ng/mL and CRP levels over 60 mg/L were associated with higher rates of admission, including to the observation ward and short-stay unit, (elevated PCT in 88% of admissions vs 36% of discharges, P<.001; elevated CRP, 72% vs 40%, P<.01), with positive blood cultures (PCT, 20% vs 2%, P<.001; CRP, 16% vs 2%, P<.01), length of hospital stay (PCT, 8.5 d vs 5.5 d, P<.01; CRP, 7 d vs 5 d, P<.01), and 30-day mortality (PCT, 21% vs 8%, P<.01; CRP, 16% vs 7%, P<.01). Conclusions: Elevated CRP levels and, in particular, elevated PCT levels can be used to differentiate between SIRS of bacterial or other aetiology. These values also indicate the need for admission and for the immediate administration of antimicrobial agents in the emergency room.

Julián Jiménez A, Ortiz Díaz-Miguel R, Palomo De Los Reyes MJ, Parejo Miguez R, Pedrosa Guerrero A, Salcedo Martínez R