Sepsis remains a life-threatening condition for which clinical diagnostic criteria lacks appropriate sensitivity and specificity (AHRQ et al. 2013). SIRS and more recently, the quick Sepsis-related Organ Failure Assessment (qSOFA) score have been used to help identify patients with suspected infection. However, evidence on the clinical utility of these scores in those with an impaired immune response remains unsubstantial. Procalcitonin (PCT) has been extensively researched as a potential adjunct to clinical judgment in diagnosing presumed infection, but its diagnostic reliability in patients with HIV/AIDS remains unclear.
We performed a single-center retrospective chart review of all patients with HIV/AIDS who were assessed for presumed infection using procalcitonin markers at Rutgers University Hospital. Subjects were divided into groups based on those that revealed an initial positive PCT (i.e. >0.5 ng/mL) and those that did not. We further examined any differences between groups using variables that assess for presumed bacterial infection.
The study comprised 58 patients with HIV/AIDS who were assessed for presumed infection using PCT markers. Patients aged between 21 and 76 years (48.5, SD 13.6), were of predominantly black race (69%), and revealed a mean CD4 count of 129 (5 to 594, SD 134). Of these patients, 46.6% (27) revealed a positive PCT. In comparison to patients with a negative PCT, there were significantly higher rates of culture proven sepsis in patients with a positive PCT (40.7% vs 9.7%, χ2= 6, p = 0.01). The proportion of HIV/AIDS patients with a positive PCT who met SIRS or qSOFA criteria upon admission was not significantly different from those with a negative PCT. In addition, no significant differences were found among groups when examining mean total CD4 count, number of days on antibiotics, length of stay, and other comorbidities such as Hepatitis C coinfection, drug, or alcohol abuse.
Patients with HIV/AIDS who presented with presumed infection and a positive initial PCT showed higher rates of culture proven sepsis despite no significant differences in initial clinical status, days of treatment, length of stay, and overall outcome. Future studies with higher power would be warranted to further assess these findings.
R. Dhiman, None
M. Feurdean, None