Antibiotics (Jun 2023)

Reduced Prognostic Role of Serum PCT Measurement in Very Frail Older Adults Admitted to the Emergency Department

  • Andrea Russo,
  • Sara Salini,
  • Giordana Gava,
  • Giuseppe Merra,
  • Andrea Piccioni,
  • Giuseppe De Matteis,
  • Gianluca Tullo,
  • Angela Novelli,
  • Martina Petrucci,
  • Antonio Gasbarrini,
  • Francesco Landi,
  • Francesco Franceschi,
  • Marcello Covino

DOI
https://doi.org/10.3390/antibiotics12061036
Journal volume & issue
Vol. 12, no. 6
p. 1036

Abstract

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Background: This study aims to evaluate the prognostic role of serum PCT in older patients with suspect sepsis or infective diagnosis in the Emergency Department (ED) with a particular focus on the clinical consequences and characteristics due to frailty status. Methods: This is a observational retrospective study conducted in the ED of a teaching hospital. We identified all consecutive patients aged ≥ 80 years admitted to the ED and subsequently hospitalized for clinical suspicion of infection. Inclusion criteria were: age ≥ 80 years and clinical suspicion of infection; availability of a PCT determination obtained 6, and patients with low or moderate frailty (CFS 1–6). A multivariate analysis was performed to calculate the adjusted odds of raised PCT values for the study endpoints. Results: In total, 1459 adults ≥ 80 years with a clinical suspicion of infection were included in the study cohort. The median age of the sample was 85 years (82–89), with 718 (49.2%) males. The multivariate models revealed that, after adjusting for significant covariates, the PCT values at ED admission were significantly associated with higher odds of infective diagnosis only in the fit/moderately frail group (Odds Ratio [95% CI] 1.04 [1.01–1.08], p 0.009) and not in very frail patients (Odds Ratio [95% CI] 1.02 [0.99–1.06], p 0.130). Similarly, PCT values were significantly associated with higher odds of in-hospital death in the fit/moderately frail group (Odds Ratio [95% CI] 1.01 [1.00–1.02], p 0.047), but not in the very frail ones (Odds Ratio [95% CI] 1.00 [0.98–1.02], p 0.948). Conversely, the PCT values were confirmed to be a good independent predictor of bloodstream infection in both the fit/moderately frail group (Odds Ratio [95% CI] 1.06 [1.04–1.08], p p < 0.001). Conclusions: The PCT values at ED admission do not predict infective diagnosis, nor are associated with higher odds of in-hospital death. Still, in frail older adults, the PCT values in ED could be a useful predictor of bloodstream infection.

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