Diagnostic Performance of Procalcitonin for the Early Identification of Sepsis in Patients with Elevated qSOFA Score at Emergency Admission

Infectious biomarkers such as procalcitonin (PCT) can help overcome the lack of sensitivity of the quick Sequential Organ Failure Assessment (qSOFA) score for early identification of sepsis in emergency departments (EDs) and thus might be beneficial as point-of-care biomarkers in EDs. Our primary aim was to investigate the diagnostic performance of PCT for the early identification of septic patients and patients likely to develop sepsis within 96 h of admission to an ED among a prospectively selected patient population with elevated qSOFA score. In a large multi-centre prospective cohort study, we included all adult patients (n = 742) with a qSOFA score of at least 1 who presented to the ED. PCT levels were measured upon admission. Of the study population 27.3% (n = 202) were diagnosed with sepsis within the first 96 h. The area under the curve for PCT for the identification of septic patients in EDs was 0.86 (95% confidence interval (CI): 0.83-0.89). The resultant sensitivity for PCT at a cut-off of 0.5 mu g/L was 63.4% (95% CI: 56.3-70.0). Furthermore, specificity was 89.2% (95% CI: 86.3-91.7), the positive predictive value was 68.8% (95% CI: 62.9-74.2), and the negative predictive value was 86.7% (95% CI: 84.4-88.7). The early measurement of PCT in a patient population with elevated qSOFA score served as an effective tool for the early identification of sepsis in ED patients.

Automated summary

The use of PCT as a biomarker in emergency departments can aid in early identification of sepsis patients. PCT demonstrated high sensitivity and specificity for identifying septic patients in EDs.