Association Between Serum Procalcitonin and 28-day Outcomes in Patients With Presumed Bacterial Sepsis at the Kenyatta National Hospital

Abstract

Introduction: Sepsis remains a major cause of mortality worldwide despite the increase in deaths due to non-communicable diseases. Poor diagnostic capability and delay in confirming appropriateness of therapy are major contributors to these poor outcomes. Serum procalcitonin has emerged as a useful tool for diagnosis and prediction of clinical outcomes in patients with sepsis.

Objective: To determine the association between change in serum procalcitonin levels and 28-day outcomes in patients with presumed bacterial sepsis.

Materials and methods: The study was conducted as an observational cohort study at the Kenyatta national hospital. Patients with presumed bacterial sepsis were evaluated for procalcitonin levels on admission and 48 hours after initiation of treatment. Patients were allocated to the 2 study arms on the basis of the change in their procalcitonin levels over the initial 48 hours, with unexposed being those with a decline greater than 30% and exposed having a rise in procalcitonin levels or a decline of less than 30%. Outcomes were documented after a 28-day follow-up period.

Clinical endpoints: The outcomes of interest were either death or discharge.

Data analysis: Kaplan-Meier curves were generated for analysis of the survival data. Intention-to-treat approach was used to analyse data on patients lost to follow up before the end of the 28-day period.

Results: More patients died in the exposed than the unexposed study arm; however this difference was not statistically significant (p=0.075). Duration of hospital stay was longer in the exposed study arm but this was also not statistically significant (p=0.077).