Disagreement on Diagnostic Use of Procalcitonin Levels

All the prior steps in the HIV care continuum are meant to culminate in viral suppression, which the CDC defines as a viral load <200 copies/mL.1 Viral suppression reduces the risk of HIV transmission by 96%. Considering less than 37% of PLWH in the United States (diagnosed and undiagnosed) receive ART, it is not surprising that 70% of PLWH have not achieved viral suppression.2 The NHAS calls for an 80% rate of viral suppression in all people in the United States with HIV by 2020. Although the NHAS goal appears ambitious, one study found that 90% of US patients who received an HIV diagnosis and were retained at each successive step of the continuum achieved viral suppression.1 Healthcare providers play a critical role in ensuring that a seropositive patient makes it through each step. Although viral suppression is the last step in the continuum, providers should not ignore quality-of-life issues that persist after viral suppression, which may cause some PLWH to regress on the continuum.1

All the prior steps in the HIV care continuum are meant to culminate in viral suppression, which the CDC defines as a viral load <200 copies/mL.1 Viral suppression reduces the risk of HIV transmission by 96%. Considering less than 37% of PLWH in the United States (diagnosed and undiagnosed) receive ART, it is not surprising that 70% of PLWH have not achieved viral suppression.2

The NHAS calls for an 80% rate of viral suppression in all people in the United States with HIV by 2020. Although the NHAS goal appears ambitious, one study found that 90% of US patients who received an HIV diagnosis and were retained at each successive step of the continuum achieved viral suppression.1 Healthcare providers play a critical role in ensuring that a seropositive patient makes it through each step. Although viral suppression is the last step in the continuum, providers should not ignore quality-of-life issues that persist after viral suppression, which may cause some PLWH to regress on the continuum.1

There is no consensus among the clinical practice guidelines on the use of procalcitonin for diagnosing infections.

There is no consensus among the clinical practice guidelines on the use of procalcitonin for diagnosing infections, according to systematic review results published in Infectious Diseases.

Procalcitonin is a prohormone in the serum that is released by various tissues after proinflammatory pathways are activated. Procalcitonin is used as an indicator for diagnosing severe bacterial infections such as sepsis, pneumonia, and bacterial meningitis and is also used to monitor treatment. Although procalcitonin has been utilized for more than 25 years, there is no agreement in the literature on its use in clinical practice and there is a lack of data on how procalcitonin is presented in clinical practice guidelines and whether it should be advocated. Therefore, this systematic review searched clinical practice guidelines and evaluated recommendations given regarding the use of procalcitonin.

The review searched 4 biomedical databases — PubMed, Scopus, Cochrane Database, and Web of Science — and various national medical sites for clinical practice guidelines; guidelines that mentioned procalcitonin were included. A total of 17 guidelines with publication dates ranging from 2009 to 2018 were included.

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The results demonstrated that clinical practice guidelines disagree on procalcitonin use. A total of 8 of the guidelines evaluated the use of procalcitonin for diagnosis, 3 for treatment monitoring, and 6 for both purposes. Procalcitonin was either recommended or it was stated that it could be useful in 12 guidelines. A total of 13 guidelines commented on other concomitant or alternate biomarkers such as C-reactive protein; 4 stated that there was a lack of evidence for recommending procalcitonin, did not recommend procalcitonin, or recommended against procalcitonin. Decision limits were suggested in 5 guidelines. Procalcitonin was not recommended in 1 national guideline, which stated that there was no need for any biomarkers in the diagnosis of community-acquired pneumonia in adults. However, no guidelines stated how often procalcitonin should be analyzed or whether it should be used in single or multiple measurements.

Overall, the study authors concluded that, “The evidence on [procalcitonin] in [clinical practice guidelines] is of low to moderate quality, and [clinical practice guidelines] disagree on [procalcitonin] use even when considering identical clinical situations.”

Reference

Tujula B, Hämäläinen S, Kokki H, Pulkki K, Kokki M. Review of clinical practice guidelines on the use of procalcitonin in infections [published online December 20, 2019]. Infect Dis. doi:10.1080/2374435.2019.1704860