Researchers in the UK have identified a promising clinical decision-making tool for sepsis that reduced mortality rates. However, the study also showed no difference in the speed of intravenous antibiotic initiation, despite initial expectations.
Sepsis is a serious complication arising from infection, which can swiftly progress to life-threatening organ failure and is responsible for around 48,000 deaths annually in England. It’s incredibly difficult to diagnose as many non-infectious illnesses can mimic the symptoms, and there is no definitive diagnostic test.
In a new study published in The Lancet Respiratory Medicine, researchers conducted a large, controlled trial that randomized 7,667 patients who presented to emergency departments with suspected sepsis.
The study tested whether adding rapid procalcitonin-guided algorithm testing to current clinical practice could help clinicians recognize sepsis more accurately, reduce unnecessary antibiotic prescribing, and maintain at least the same level of patient safety, measured by overall mortality.
A procalcitonin‑guided algorithm is a clinical decision‑making tool that uses levels of the biomarker procalcitonin (PCT) to help guide antibiotic therapy in patients with suspected bacterial infections. However, it is not currently recommended for use in emergency settings because previous research has been inconsistent.
Ultimately, the study showed there was a 17% reduction in mortality from 16.6% to 13.6%, which means for every 1,000 patient treated as suspected sepsis, 31 lives are potentially saved. Additionally, patients from the most deprived areas experienced the greatest mortality benefit.
Importantly, the trial found that regardless of whether patients were treated with the procalcitonin‑guided algorithm or received standard care, there was no difference in how quickly intravenous antibiotics were started. Although the research team had anticipated that the algorithm might improve early antibiotic initiation, the trial showed it did not—a key finding, given this was one of the co‑primary outcomes.
Data from University of Liverpool