Russo Andrea, Salini Sara, Gava Giordana, Merra Giuseppe, Piccioni Andrea, De Matteis Giuseppe, Tullo Gianluca, Novelli Angela, Petrucci Martina, Gasbarrini Antonio, Landi Francesco, Franceschi Francesco, Covino Marcello
Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy.
Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Antibiotics (Basel). 2023 Jun 10;12(6):1036. doi: 10.3390/antibiotics12061036.
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.
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 < 24 h since ED access; and Clinical Frailty Scale (CFS) determination. Study endpoints were the diagnostic accuracy of PCT for all-cause in-hospital death, infective diagnosis at discharge, and bloodstream infection. Diagnostic accuracy was calculated via ROC analysis and compared in the patients with severe frailty, measured by CFS > 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.
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], 0.009) and not in very frail patients (Odds Ratio [95% CI] 1.02 [0.99-1.06], 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], 0.047), but not in the very frail ones (Odds Ratio [95% CI] 1.00 [0.98-1.02], 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], < 0.001) and the very frail group (Odds Ratio [95% CI] 1.05 [1.03-1.07], < 0.001).
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.
本研究旨在评估血清降钙素原（PCT）在急诊科疑似脓毒症或感染性诊断的老年患者中的预后作用，特别关注因虚弱状态导致的临床后果和特征。
这是一项在教学医院急诊科进行的观察性回顾性研究。我们确定了所有连续入住急诊科且随后因临床怀疑感染而住院的80岁及以上患者。纳入标准为：年龄≥80岁且临床怀疑感染；自进入急诊科起<24小时内获得的PCT测定结果；以及临床衰弱量表（CFS）测定结果。研究终点为PCT对全因院内死亡、出院时感染性诊断和血流感染的诊断准确性。通过ROC分析计算诊断准确性，并在CFS>6测量的严重虚弱患者和低或中度虚弱（CFS 1-6）患者中进行比较。进行多变量分析以计算研究终点时PCT值升高的调整后比值比。
共有1459名临床怀疑感染的80岁及以上成年人纳入研究队列。样本的中位年龄为85岁（82-89岁），男性718名（49.2%）。多变量模型显示，在调整显著协变量后，急诊科入院时PCT值仅在健康/中度虚弱组与感染性诊断的较高比值比显著相关（比值比[95%置信区间]1.04[1.01-1.08]，P=0.009），而在非常虚弱的患者中不相关（比值比[95%置信区间]1.02[0.99-1.06]，P=0.130）。同样，PCT值在健康/中度虚弱组与院内死亡的较高比值比显著相关（比值比[95%置信区间]1.01[1.00-1.02]，P=0.047），但在非常虚弱的患者中不相关（比值比[95%置信区间]1.00[0.98-1.02]，P=0.948）。相反，PCT值在健康/中度虚弱组（比值比[95%置信区间]1.06[1.04-1.08]，P<0.001）和非常虚弱组（比值比[95%置信区间]1.05[1.03-1.07]，P<0.001）均被证实是血流感染的良好独立预测指标。
急诊科入院时的PCT值不能预测感染性诊断，也与院内死亡的较高比值比无关。然而，在虚弱的老年人中，急诊科的PCT值可能是血流感染的有用预测指标。
