Low Procalcitonin Levels Are Associated With Higher 30-Day Readmission Rates for Pneumonia

Abstract

Purpose: Procalcitonin (PCT) levels are elevated in patients with bacterial infection. PCT-guided algorithms have been shown to reduce the duration of antibiotic usage in patients with acute respiratory infections, without an increase in mortality1 or overall treatment failure2. The major potential benefits of PCT-guided care include minimizing unnecessary antibiotics, complications due to these medications and reducing overall cost. The Centers for Medicare & Medicaid Services (CMS) have established and report 30 day readmission rates following discharge after pneumonia as important quality outcome measures for all hospitals. With the initiation of PCT testing in our institution in November of 2013, we decided to look at the relationship of 30 day readmit rate in pneumonia patients for 1 year before and after this date. Methods: We retrospectively studied all hospital patients included and reported in the hospital "30 day readmission for pneumonia" quality indicator from Nov 1, 2012 to Oct 31, 2014. Once PCT testing became available in Nov 1, 2013, we compared the readmission rates to PCT levels. Our hospital algorithm suggests discontinuation of antibiotics with a PCT < 0.25 ng/mL. Results: From November 1, 2012 to October 31, 2013, before PCT testing was available, 79 of 655 (12.1%) pneumonia patients were admitted within 30 days. From November 1, 2013 to October 31, 2014, once PCT testing was available, the 30 day readmission rate was 67 of 739 patients (9.1%). Only 96 of these 739 patients (13.0%) admitted with pneumonia from November 2013 to October 2014 had PCT testing. In patients with a PCT 0.25 ng/mL, the readmission rate was 3 of 33 patients (9.1%). Conclusions: In the first year of its availability, the overall utilization of PCT testing in pneumonia patients was quite low (13.0%). Patients with low PCT level had a higher 30 day readmission rate than those with high PCT levels, 25.4% vs 9.1%, respectively. Clinical Implications: Patients admitted for pneumonia and a high PCT level have a lower 30 day readmission rate. A low PCT level in patients admitted with pneumonia may be predictive of a higher readmission within 30 days, possibly due to a shorter duration of anitbiotic use in these patients. Future studies evaluating PCT, duration of antibiotic use and 30 day hospital readmission should be conducted.