Procalcitonin Is Effective Biomarker for Guiding Antibiotic Treatment in Sepsis

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Sepsis contributes significantly to morbidity and mortality in hospitalized patients.
Sepsis contributes significantly to morbidity and mortality in hospitalized patients.

Procalcitonin is an effective biomarker for infection, and it can be used to determine antibiotic discontinuation in patients with suspected or confirmed sepsis, without causing adverse effects on outcomes, according to new findings published in Critical Care Medicine.

The authors conducted a systematic review and meta-analysis in order to summarize the current clinical evidence pertaining to the effectiveness and safety of procalcitonin guidance vs standard of care in adults with confirmed or suspected sepsis.

The research was also conducted as part of a regulatory submission to the US Food and Drug Administration.  A total of 10 randomized controlled trials that included 3489 patients were used in the analysis.

The overall mean duration of antibiotic therapy was 7.35 days in the procalcitonin arms vs 8.85 days in the control arms, and both random effects and fixed effects models demonstrated this as a statistically significant reduction in duration (random effects weighted mean differences [WMD], -1.49 days; 95% CI, -2.27 to 0.71; P <.001).

The overall mean length of stay in intensive care was 11.09 days in the treatment arms and 11.91 days for controls; no statistically significant difference was seen between the treatment arms (random effects WMD, -0.84 days; 95% CI, -2.52 to 0.84; P =.329). Several studies also looked at mortality, but the pooled risk ratio (RR) associated with procalcitonin was not statistically significant (random effects RR, 0.90; 95% CI, 0.79-1.03; P =.114).

“In light of the positive effect of [procalcitonin] on reducing [antibiotic] with no observed adverse impact on key safety outcomes, the use of [procalcitonin] as a biomarker to guide [antibiotic] treatment decision-making has the potential to improve the quality of care for adults with confirmed or suspected sepsis,” the authors conclude.

Reference

Iankova I, Thompson-Leduc P, Kirson NY, Rice B, et al. Efficacy and safety of procalcitonin guidance in patients with suspected or confirmed sepsis: a systematic review and meta-analysis. Crit Care Med. 2018;46(5):691-698.

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