Prokalzitoninbasierte Algorithmen

Hochreiter, Marcel; Schroeder, Stefan

doi:10.1007/s00101-011-1884-1

Cited by 16 publications

(5 citation statements)

References 79 publications

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“…Using PCT-based algorithms to monitor and manage antibiotic treatment saves ABD and ICUD as well as cost for antibiotics (by the effect of allowing an early de-escalation strategy). This has been proven in PCT-related RCTs and verified in meta-analyses and reviews [7,8,10,11]. …”

Section: Introductionmentioning

confidence: 70%

“…Therefore we took the assumption that 8 PCT-test will be a realistic frequency. We developed an algorithm based on recent reviews and publications on PCT in sepsis patients [7,13]. The findings from Charles et.al.…”

Section: Resultsmentioning

confidence: 99%

“…Using the results from a recent review on PCT-based algorithms for the management of infections [7], we calculated an average utilization of 7 subsequent PCT-tests. The average cost for a PCT-test in Germany is € 25 (based on data from the vendor).…”

Section: Methodsmentioning

confidence: 99%

“…As data on intermediate care stays were not available, we chose this conservative approach in order to avoid overestimation of possible savings. Costs for antibiotic treatment in sepsis vary [3,7,13]. We chose to build a flexible range for these costs in our simulation model with average daily costs of € 66…”

Section: Methodsmentioning

confidence: 99%

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The use of a standardized PCT-algorithm reduces costs in intensive care in septic patients - a DRG-based simulation model

Wilke¹,

Grube²,

Bodmann³

2011

Eur J Med Res

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IntroductionThe management of bloodstream infections especially sepsis is a difficult task. An optimal antibiotic therapy (ABX) is paramount for success. Procalcitonin (PCT) is a well investigated biomarker that allows close monitoring of the infection and management of ABX. It has proven to be a cost-efficient diagnostic tool. In Diagnoses Related Groups (DRG) based reimbursement systems, hospitals get only a fixed amount of money for certain treatments. Thus it's very important to obtain an optimal balance of clinical treatment and resource consumption namely the length of stay in hospital and especially in the Intensive Care Unit (ICU). We investigated which economic effects an optimized PCT-based algorithm for antibiotic management could have.Materials and methodsWe collected inpatient episode data from 16 hospitals. These data contain administrative and clinical information such as length of stay, days in the ICU or diagnoses and procedures. From various RCTs and reviews there are different algorithms for the use of PCT to manage ABX published. Moreover RCTs and meta-analyses have proven possible savings in days of ABX (ABD) and length of stay in ICU (ICUD). As the meta-analyses use studies on different patient populations (pneumonia, sepsis, other bacterial infections), we undertook a short meta-analyses of 6 relevant studies investigating in sepsis or ventilator associated pneumonia (VAP). From this analyses we obtained savings in ABD and ICUD by calculating the weighted mean differences. Then we designed a new PCT-based algorithm using results from two very recent reviews. The algorithm contains evidence from several studies. From the patient data we calculated cost estimates using German National standard costing information for the German G-DRG system.We developed a simulation model where the possible savings and the extra costs for (in average) 8 PCT tests due to our algorithm were brought into equation.ResultsWe calculated ABD savings of -4 days and ICUD reductions of -1.8 days. our algorithm contains recommendations for ABX onset (PCT ≥ 0.5 ng/ml), validation whether ABX is appropriate or not (Delta from day 2 to day 3 ≥ 30% indicates inappropriate ABX) and recommendations for discontinuing ABX (PCT ≤ 0.25 ng/ml).We received 278, 264 episode datasets where we identified by computer-based selection 3, 263 cases with sepsis. After excluding cases with length of stay (LOS) too short to achieve the intended savings, we ended with 1, 312 cases with ICUD and 268 cases without ICUD. Average length of stay of ICU-patients was 27.7 ± 25.7 days and for Non-ICU patients 17.5 ± 14.6 days respectively. ICU patients had an average of 8.8 ± 8.7 ICUD.After applying the simulation model on this population we calculated possible savings of € -1, 163, 000 for ICU-patients and € -36, 512 for Non-ICU patients.DiscussionOur findings concerning the savings from the reduction of ABD are consistent with other publications. Savings ICUD had never been economically evaluated so far. our algorithm is able to possibly set a new ...

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Section: Introductionmentioning

confidence: 70%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The use of a standardized PCT-algorithm reduces costs in intensive care in septic patients - a DRG-based simulation model

Wilke¹,

Grube²,

Bodmann³

2011

Eur J Med Res

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“…Specific biomarkers with an established role in sepsis include C-reactive protein (CRP) [2], procalcitonin (PCT) [3], lactate, cytokines, coagulation parameters, and others. These markers are used both clinically and experimentally to diagnose sepsis and guide treatment [4–6]. …”

Section: Introductionmentioning

confidence: 99%

Soluble receptor for advanced glycation end products predicts 28-day mortality in critically ill patients with sepsis

Brodská¹,

Malíčková²,

Valenta

et al. 2013

Scandinavian Journal of Clinical and Laboratory Investigation

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Objective Multiple biomarkers are used to assess sepsis severity and prognosis. Increased levels of the soluble receptor for advanced glycation end products (sRAGE) were previously observed in sepsis but also in end-organ injury without sepsis. We evaluated associations between sRAGE and (i) 28-day mortality, (ii) sepsis severity, and (iii) individual organ failure. Traditional biomarkers procalcitonin (PCT), C-reactive protein (CRP) and lactate served as controls. Methods sRAGE, PCT, CRP, and lactate levels were observed on days 1 (D1) and 3 (D3) in 54 septic patients. We also assessed the correlation between the biomarkers and acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and acute heart failure. Results There were 38 survivors and 16 non-survivors. On D1, non-survivors had higher sRAGE levels than survivors (p = 0.027). On D3, sRAGE further increased only in non-survivors (p < 0.0001) but remained unchanged in survivors. Unadjusted odds ratio (OR) for 28-day mortality was 8.2 (95% CI: 1.02–60.64) for sRAGE, p = 0.048. Receiver operating characteristic analysis determined strong correlation with outcome on D3 (AUC = 0.906, p < 0.001), superior to other studied biomarkers. sRAGE correlated with sepsis severity (p < 0.00001). sRAGE showed a significant positive correlation with PCT and CRP on D3. In patients without ARDS, sRAGE was significantly higher in non-survivors (p < 0.0001) on D3. Conclusion Increased sRAGE was associated with 28-day mortality in patients with sepsis, and was superior compared to PCT, CRP and lactate. sRAGE correlated with sepsis severity. sRAGE was increased in patients with individual organ failure. sRAGE could be used as an early biomarker in prognostication of outcome in septic patients.

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Antibiotika, Antibiotikaprophylaxe und Antimykotika in der Intensivmedizin

Lemmen¹

2015

Die Intensivmedizin

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Prokalzitoninbasierte Algorithmen

Cited by 16 publications

References 79 publications

The use of a standardized PCT-algorithm reduces costs in intensive care in septic patients - a DRG-based simulation model

The use of a standardized PCT-algorithm reduces costs in intensive care in septic patients - a DRG-based simulation model

Soluble receptor for advanced glycation end products predicts 28-day mortality in critically ill patients with sepsis

Antibiotika, Antibiotikaprophylaxe und Antimykotika in der Intensivmedizin

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