5PSQ-102 Evaluation of the correlation between procalcitonin (PCT) level and other biomarkers, sepsis diagnosis and antibiotic prescription pattern at an emergency department (ED)

<h3>Background and Importance</h3> Sepsis is a life-threatening condition with a rapid progressivity and high mortality rate. The diagnosis and antimicrobial treatment of sepsis remains a challenge for prescribers and common source for misdiagnosis. <h3>Aim and Objectives</h3> This retrospective observational study aimed to evaluate the correlation between PCT level, sepsis diagnosis and first empirical antibiotic therapy. <h3>Material and Methods</h3> The study was conducted at an Emergency Department (ED) unit of a tertiary care medical centre in Hungary in December 2023. We included all adult patients who had procalcitonin level &gt;0.1ng/ml. Diagnosis and severity of sepsis was defined by ‘SIRS, Sepsis, and Septic Shock Criteria’ using MDCalc. Clinical presentation, possible source of infection, and cultures taken were also considered. Misdiagnosis was defined when patients did not meet SIRS criteria. Analyses for empirical antibiotic therapy were performed only for confirmed sepsis. Fisher’s exact test and t-test were applied to compare categorical and continuous variables between groups. <h3>Results</h3> Out of 199 cases in 39.2% (n=78) the recorded diagnosis was sepsis, of which 21.6% (n=43) have not met sepsis criteria. In fact, out of the remain 121 patients recorded with other diagnosis 23.1% (n=46) has met sepsis criteria, so they were misdiagnosed. The most common bacterial infections were pneumonia (53.2%), urinary tract infections (20.3%), and chronic skin and soft-tissue infections (10.1%). The cut-off value of PCT for the diagnosis of sepsis (group 1) was 0.76 ng/ml, while for other diagnosis (group 2) 0.41ng/ml (p&gt;0.05). However, we found a significant (p&lt;0.05) difference between groups in cut-off values for C-reactive protein (158 vs 122mg/L) and white blood cells (15.6 vs 11.4G/L). Antibiotic therapy in sepsis at ED was substantially low (37%, 26/79), out of which only 9% (7/79) was administered definitely within 3 hours. Our results show that PCT values have influenced antibiotic therapy as following: 0.33ng/ml-no antibiotic therapy, 0.44ng/ml-within 3 hours, 1.4ng/ml-between 3 and 6 hours. However, in case of administration over 6 hours PCT cut-off value was 4.76mg/ml. Patients administered antibiotic within 3 hours had the shortest length of stay (median 6 days). <h3>Conclusion and Relevance</h3> We found a relatively high rate of misdiagnosed sepsis. Knowing PCT cut-off values may help antibiotic prescribers is decision making process. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest