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Efficacy and Safety of Procalcitonin Guidance in Patients with Suspected or Confirmed Sepsis: A Systematic Review and Meta-Analysis
Iankova I, Thompson-Leduc P, Kirson NY, et al. Crit Care Med. 2018; 46: 691-98.
Study Question: What evidence exists around the safety and efficacy of procalcitonin (PCT) guided antimicrobial therapy compared to standard of care in patients with suspected or confirmed sepsis?
Study Description: Articles published in peer reviewed journals from 2004 to 2016 were searched by an algorithm in PubMed and the Cochrane Database of Systematic Reviews. Articles were reviewed by two independent reviewers and excluded if no original study data were presented, patients did not have suspected or confirmed sepsis, PCT was not used to guide antibiotic clinical decision making, absence of control group, PCT was not the focus of the trial, the article was not in English, pediatric patients included, and article was only available in abstract form. The authors identified 354 articles, of which 10 randomized controlled trials were included. Effectiveness was measured by antimicrobial duration. Safety was measured by ICU length of stay (LOS) and all-cause mortality.
Results: Patients with a PCT-guided de-escalation strategy had shorter duration of antibiotics compare to control (7.35 vs. 8.85 days; 95% CI, –2.27 to –0.71; p < 0.001). There was no statistically significant difference in mortality (risk ratio, 0.90; 95% CI, 0.79–1.03; p = 0.114) or ICU LOS (11.09 d vs. 11.91; 95% CI, –2.52 to 0.84; p = 0.329) for the PCT group compared to placebo.
Conclusion(s): PCT is an effective biomarker in guiding antibiotic discontinuation in patients with suspected or confirmed sepsis compared with the standard of care.
Perspective: Findings of this meta-analysis are similar to a previous meta-analyses and trials that have examined PCT in sepsis and septic shock. However, there was a high level of heterogeneity for antibiotic duration and ICU LOS. Additionally, there were many missing data that created outliers in the meta-analysis. Although procalcitonin has been shown to be a useful tool in decreasing antibiotic days, the most appropriate timing of procalcitonin levels and the subset of patients in which it is most useful still remains unanswered.