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Recognizing Sepsis

Early detection using PCT testing is vital to infection control and increases survival rates in patients who develop deadly sepsis.

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A life-threatening complication of an infection, sepsis can happen to anyone.

Like 12-year-old Rory Staunton, who received a minor cut on his arm in gym class and died four days later in the ICU from severe septic shock brought on by an unnoticed bloodstream infection.

Staunton's story, which was profiled in The New York Times, highlights the need for healthcare providers to identify and treat the ailment before it's too late.

In fact, in the presence of septic shock, each hour delay in antibiotic administration has been found to decrease survival by 7.6 percent.1

"Early detection of severe sepsis is crucial to decrease organ damage and improve survival," noted Katherine L. McDowell, MSN, RN, former clinical quality consultant and nurse champion for Sepsis: Early Goal Directed Therapy at Decatur Memorial Hospital, Decatur, IL.

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Rapidly Progressing Condition

Caused by an immune response to infection, sepsis is one of the leading causes of death in the ICU. It develops unpredictably and quickly advances.

In some literature, sepsis has been referred to as a syndrome, with the likely possibility of progressing to septic shock if not treated. When a patient goes into septic shock, multiple organs can swiftly fail, resulting in death.2

"As with any infection, the very young, very old and immunocompromised individuals are at greatest risk of developing sepsis," said Erica C. DeBoer, MA, RN, CNL, CCRN, clinical nurse leader at Sanford USD Medical Center in Sioux Falls, SD.

Approximately 750,000 Americans are affected by sepsis each year. Of that number, between 28 and 50 percent die, which is more than deaths from prostate cancer, breast cancer and AIDS combined in the U.S.3

"Based on the physiological nature of sepsis and the potential to escalate to septic shock, early identification and treatment is crucial in the effective management of these patients," said DeBoer.

A Challenging Diagnosis

Because the assessment of infection in critically ill patients can be confusing and challenging, early detection isn't always easy, acknowledged McDowell. In fact, intensive care professionals consider sepsis to be one of the most challenging and difficult conditions to manage.

"Diagnosis can be tricky based on how the patient presents, especially in the early stages of sepsis or for those patient who are immunocompromised, very young or old," explained DeBoer, noting that the typical symptoms of sepsis may be masked making diagnosis difficult.

In addition, the normal set of blood culture with results in 48 hours does not offer the in-the-moment information needed to treat a septic patient, nor prevent progression to septic shock and multi-organ dysfunction.

A variety of lab tests are used in combination for the diagnosis and many healthcare professionals may be involved in the diagnosis and treatment of sepsis.

"Senior clinicians need to be convinced that compliance with evidenced-based interventions, such as early goal-directed therapy, in the treatment of sepsis will add value to their patient care," McDowell said.

"Organizations must focus on the processes designed to decrease fragmentation within and across departments, resulting in cultural change, and to eliminate organizational constraints."4

Early Detection by PCT Testing

Procalcitonin (PCT) testing is a fast and effective blood test that can assess patients early in their disease process. A PCT level is obtained by simple blood test with results in less than 1 hour.

PCT can also be effective when ordered at intervals to monitor the effectiveness of antibiotic treatment. PCT levels can be useful for the management of patients after surgery or transplant and in peritonitis.

"Adding PCT results to clinical assessment improves the accuracy of the early clinical diagnosis of sepsis," noted DeBoer.

PCT can aid in the diagnosis and severity stratification in patients suspected of sepsis, severe sepsis and septic shock. In multiple studies, PCT has demonstrated a high sensitivity and specificity for the differentiation of sepsis from systemic inflammatory response syndrome.

PCT is typically produced by C-cells in the thyroid and a few neuroendocrine cells in the lungs, noted McDowell.

"In a healthy individual, PCT cleaves to the hormone calcitonin and helps balance calcium and phosphorus in the body. Additionally, PCT assists with bone metabolism. Normally, there is little to no PCT circulating in the body," she said.

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However, in the presence of a bacterial infection, PCT no longer cleaves to calcitonin. The infection produces a rapid rise of PCT levels in the blood, which can be detected as early as three hours after the onset of bacterial infection and can reach maximum levels in 6-12 hours.

"PCT testing truly becomes another tool in your pocket in order to assess and identify patients that are in the early stages of sepsis," stated DeBoer.

Sepsis continues to be a huge challenge in healthcare across the nation and hospitalized patient populations are growing and are more complex than ever.

"Recognition is the key to reducing not only mortality, but the extent of illness and injury, which results in increased length of stay and costs," DeBoer said.

Early recognition is key to improved outcomes for patients with severe sepsis. The earlier the patient is identified, the faster early goal-directed therapy can begin.

"If detected early, sepsis can be reversed," concluded McDowell.

References for this article can be accessed here.

Beth Puliti is a frequent contributor to ADVANCE.


 

How common is PCT testing by the American Hospitals ?

Nina Stolpe,  CCRNNovember 22, 2012
Kerrville, TX




     

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