Does a prolactin level screen for sepsis?

Prolactin Does Not Screen for Sepsis

No, prolactin levels should not be used to screen for sepsis. The Surviving Sepsis Campaign guidelines, which represent the international consensus for sepsis management, do not include prolactin measurement in any screening, diagnostic, or management recommendations for sepsis 1.

What the Guidelines Actually Recommend for Sepsis Screening

The established screening approach for sepsis focuses on entirely different biomarkers and clinical parameters:

• Lactate measurement is the recommended biomarker for identifying tissue hypoperfusion in sepsis, with levels ≥4 mmol/L defining sepsis-induced tissue hypoperfusion and requiring immediate protocolized resuscitation 1

• Procalcitonin (not prolactin) is the biomarker mentioned in sepsis guidelines, specifically for assisting in discontinuation of empiric antibiotics in patients who initially appeared septic but have no subsequent evidence of infection 1

• Routine screening protocols should focus on clinical signs of infection combined with evidence of organ dysfunction (SOFA score ≥2 points), vital sign abnormalities, and lactate levels 1, 2

Why Prolactin Is Not Used for Sepsis Screening

While research shows that prolactin levels may be elevated in septic patients and associated with certain complications like delirium, this does not make it a screening tool 3, 4. The key distinctions are:

• No guideline support: Zero major sepsis guidelines (Surviving Sepsis Campaign 2012,2016, or subsequent updates) recommend prolactin measurement for sepsis screening, diagnosis, or management 1

• Research context only: Studies examining prolactin in sepsis are investigating pathophysiology and associations (such as with delirium or immune function), not establishing it as a diagnostic or screening test 3, 5, 4, 6

• Lack of diagnostic accuracy data: Unlike procalcitonin, which has been studied for diagnostic accuracy in sepsis (albeit with limited performance), prolactin has not been validated as a sepsis screening or diagnostic tool 7

The Correct Screening Approach

For sepsis screening in acutely ill patients, measure:

• Lactate levels in all patients with suspected infection and signs of organ dysfunction, with ≥2 mmol/L indicating potential tissue hypoperfusion warranting investigation 8, 2

• Vital signs including blood pressure (MAP target ≥65 mmHg), heart rate, respiratory rate, temperature, and oxygen saturation 1

• Evidence of organ dysfunction using SOFA score criteria (altered mental status, respiratory dysfunction, hypotension, renal dysfunction, hepatic dysfunction, coagulopathy) 2

• Blood cultures before antimicrobial therapy if no significant delay (<45 minutes) in starting antibiotics 1

The screening algorithm should be:

1. Identify suspected infection based on clinical presentation
2. Assess for organ dysfunction (SOFA ≥2 points)
3. Measure serum lactate immediately
4. If lactate ≥4 mmol/L or persistent hypotension: initiate immediate protocolized resuscitation 1
5. If lactate 2-4 mmol/L: begin aggressive fluid resuscitation with 30 mL/kg IV crystalloid within 3 hours 8

Common Pitfall to Avoid

Do not confuse procalcitonin (PCT) with prolactin—these are completely different molecules with different clinical applications. Procalcitonin has a role (albeit limited) in sepsis management for antibiotic de-escalation, while prolactin has no established role in sepsis screening or management 1, 7.