Background: Procalcitonin (PCT) is specifically up-regulated in bacterial infections and its role as a biomarker of infection has been extensively investigated. However, not much is known about the epidemiology and current use patterns of PCT in the United States.
Methods: Inpatient and emergency room encounters from adult patients (age 18+) between January 1st, 2007 and June 30th, 2015 at 513 hospitals in the PremierTM Healthcare Database (PHD) were identified. Eight-year trends were examined in (1) PCT use-density by encounter and (2) prevalence of inpatient PCT encounters involving ICU stays compared to C-reactive protein (CRP) encounters involving ICU stays. National prevalence of inpatient PCT-encounters was estimated by applying hospital-level weights to match the hospital distribution in the American Hospital Association Annual Survey to inpatient PCT hospitalizations between July 1st, 2014 and June 30th, 2015.
Results: Between 2014-15, 30-million patients were admitted to U.S. hospitals, of which 1.46 million received ³1 PCT test (annual prevalence 49.3/1000 hospitalizations). The top three principal discharge diagnoses among PCT-encounters were septicemia (31%), respiratory conditions (18%) and heart failure (7%). There was a six-fold higher likelihood of PCT use during encounters where the physician-of-record was an internist rather than a surgeon. PCT-use prevalence was conspicuously lower at teaching compared to non-teaching hospitals and in the Northeast compared to other regions (Table 1). A third of PCT encounters involved an ICU stay. Trends in PCT-use density varied considerably by encounter type (Figure 1). Between 2007-15, PCT use in the inpatient ICU population rose sharply from 0 to 11.7% while CRP use rose from 5.5% in 2007 to 8.4% in 2011 and plateaued thereafter (Figure 2).
Conclusion: The use of PCT has escalated across United States hospitals in recent years, especially in the critically ill, whereas the use of CRP has plateaued. Today, PCT guidance is sought in the care of one in every twenty hospitalized adult patients in the United States. In light of an unclear benefit on patient outcomes, PCT-guided antibiotic management in the real world warrants further investigation.
Z. Cao, Premier Research Services: Employee of Premier Research Services which received money to perform the study , Employee of Premier Research Services which received money to perform the study
S. B. Robinson, biomerieux: Employee of Premier Research Services which received money to perform the study , Research support
C. B. Lipkin, Premier Research Services: Employee of Premier Research Services which received money to perform the study , Employee of Premier Research Services which received money to perform the study
S. Bozzette, BioMerieux: Employee , Salary
R. Balk, biomerieux: Investigator , Scientific Advisor and speaker , Consulting fee , Research grant and Speaker honorarium
thermoFisher: Scientific Advisor , Consulting fee
Roche Scientific: Scientific Advisor , Consulting fee
CDC: Investigator , Research support