The precision of procalcitonin as a biomarker for sepsis in adult emergency department visits: A systematic review

Background: Sepsis is a life-threatening condition and a significant cause of mortality among patients presenting to emergency departments (EDs). Early diagnosis is essential to initiate treatment and improve outcomes. Procalcitonin (PCT), level increase in response to bacterial infection, has been recently examined for its role in diagnosing and prognosticating sepsis. This systematic review aimed to evaluate the diagnostic accuracy of PCT in adult patients with suspected sepsis in the ED setting. Methods: The review was conducted in accordance with PRISMA guidelines. We conduct a literature search of PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2015 and 2024. Studies were included if they investigated serum PCT levels in adult ED patients with sepsis and reported diagnostic or prognostic outcomes. Nine eligible original studies were included. Results: Procalcitonin show a moderate to high specificity in differentiating sepsis from non-infectious conditions. Elevated PCT on admission were associated with higher risks of septic shock, bacteremia, and mortality. Sensitivity differs depending on disease stage and patient population. PCT was enhanced when combined with other biomarkers or scoring systems such as IL-6, MDW, or qSOFA. Conclusion: PCT is a useful biomarker for early sepsis detection in emergency settings. Its use in combination with clinical tools provide better diagnostic accuracy and improve patient management.