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Procalcitonin testing: reducing the risk of sepsis-related mortality

Edward Burnham looks at the use of procalcitonin as a biomarker for sepsis, which could provide greater specificity than previously possible, ensuring timely, effective and cost-effective treatment.

Sepsis is the body’s ongoing systemic inflammatory response to a bacterial infection. According to the Centers for Disease Control and Prevention, sepsis is the primary cause of death in non-coronary intensive care units (ICU). As with disorders such as acute myocardial ischaemic attack, timely diagnosis is essential to ensure that appropriate and effective treatment is administered. Research has shown that for every hour delay in the administration of appropriate antibiotic therapy, there is an associated 7% rise in mortality.

The condition is relatively common and as a result has a major impact on healthcare expenditure and resources.2 In Europe, cases of sepsis have been estimated at 90.4 per 100,000 population. To put this in context, the incidence of breast cancer is 58 per 100,000.3 Therefore, in a lifetime, an individual is around 60% more likely to develop severe sepsis than to be diagnosed with breast cancer. In 2009, the worldwide documented incidence of sepsis was 1.8 million cases annually; however, this figure reflected low rates of recognition and diagnosis and the causative pathology (eg pneumonia) rather than sepsis. Later estimates suggest around two million cases are admitted to intensive care units alone.4,5

Critical care units (incorporating intensive care and high-dependency care in most UK hospitals) are among the most expensive areas for patient care. This arises from the high nurse-to-patient ratio needed to provide the required level of care. In the UK, most units estimate that a typical bed day costs around £1500. The cost for patients with severe sepsis is likely to be higher. In European studies, it has been estimated that a typical episode of severe sepsis costs a healthcare organisation approximately €25,000.6 Assuming that there are 100,000 cases of severe sepsis per annum, this equates to a direct cost to the NHS of over £2.3 billion. The annual cost to Europe as a whole has been estimated to be approximately €7.6 billion.3

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