Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Dec 11;17(6):R291.
doi: 10.1186/cc13157.

Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock--a systematic review and meta-analysis

Anna Prkno, Christina Wacker, Frank M Brunkhorst, Peter Schlattmann
Meta-Analysis

Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock--a systematic review and meta-analysis

Anna Prkno et al. Crit Care. .

Abstract

Introduction: Procalcitonin (PCT) algorithms for antibiotic treatment decisions have been studied in adult patients from primary care, emergency department, and intensive care unit (ICU) settings, suggesting that procalcitonin-guided therapy may reduce antibiotic exposure without increasing the mortality rate. However, information on the efficacy and safety of this approach in the most vulnerable population of critically ill patients with severe sepsis and septic shock is missing.

Method: Two reviewers independently performed a systematic search in PubMed, Embase, ISI Web of Knowledge, BioMed Central, ScienceDirect, Cochrane Central Register of Controlled Trials, http://www.ClinicalTrials.gov and http://www.ISRCTN.org. Eligible studies had to be randomized controlled clinical trials or cohort studies which compare procalcitonin-guided therapy with standard care in severe sepsis patients and report at least one of the following outcomes: hospital mortality, 28-day mortality, duration of antimicrobial therapy, length of stay in the intensive care unit or length of hospital stay. Disagreements about inclusion of studies and judgment of bias were solved by consensus.

Results: Finally seven studies comprising a total of 1,075 patients with severe sepsis or septic shock were included in the meta-analysis. Both hospital mortality (RR [relative risk]: 0.91, 95%CI [confidence interval]: 0.61; 1.36) and 28-day mortality (RR: 1.02, 95%CI: 0.85; 1.23) were not different between procalcitonin-guided therapy and standard treatment groups. Duration of antimicrobial therapy was significantly reduced in favor of procalcitonin-guided therapy (HR [hazard ratio]: 1.27, 95%CI: 1.01; 1.53). Combined estimates of the length of stay in the ICU and in hospital did not differ between groups.

Conclusion: Procalcitonin-guided therapy is a helpful approach to guide antibiotic therapy and surgical interventions without a beneficial effect on mortality. The major benefit of PCT-guided therapy consists of a shorter duration of antibiotic treatment compared to standard care. Trials are needed to investigate the effect of PCT-guided therapy on mortality, length of ICU and in-hospital stay in severe sepsis patients.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram. Study identification and selection process. SIRS, systemic inflammatory response syndrome; ACCP, American College of Chest Physicians; SCCM, Society of Critical Care Medicine; PCT, procalcitonin. *, available online at http://www.ClinicalTrials.gov.
Figure 2
Figure 2
Risk of bias summary. Cochrane Collaboration tool for assessing risk of bias. Review authors’ judgments about each risk of bias item for each included study. +, low risk of bias; -, high risk of bias; ?, unclear risk of bias.
Figure 3
Figure 3
Forest plot - hospital mortality. The forest plot represents the relative risk (RR) together with the 95% CI comparing patients treated in the procalcitonin (PCT) and the control groups (Control). Events, number of deceased patients in group; Experimental, PCT group; Total, number of all patients in group; W, weight of individual studies (in fixed- and random-effects model).
Figure 4
Figure 4
Forest plot - 28-day mortality. The forest plot represents the relative risk (RR) together with the 95% CI comparing patients treated in the procalcitonin (PCT) and the control groups (Control). Events, number of deceased patients in group; Experimental, PCT group; Total, number of all patients in group; W, weight of individual studies (in fixed- and random-effects model).
Figure 5
Figure 5
Forest plot - duration of antimicrobial therapy. The forest plot represents the hazard ratios (HRs) together with the 95% CIs comparing patients treated in the procalcitonin (PCT) and the control groups. SE, standard error; W, weight of individual studies (in fixed- and random-effects model).
Figure 6
Figure 6
Forest plot - length of stay in the ICU. The forest plot represents the hazard ratios (HRs) together with the 95% CIs comparing patients treated in the procalcitonin (PCT) and the control groups. SE, standard error; W, weight of individual studies (in fixed- and random-effects model).
Figure 7
Figure 7
Forest plot - length of stay in the hospital. The forest plot represents the hazard ratios (HRs) together with the 95% CIs comparing patients treated in the procalcitonin (PCT) and the control groups. SE, standard error; W, weight of individual studies (in fixed- and random-effects model).
See this image and copyright information in PMC

Comment in

References

    1. Engel C, Brunkhorst FM, Bone HG, Brunkhorst R, Gerlach H, Grond S, Gruendling M, Huhle G, Jaschinski U, John S, Mayer K, Oppert M, Olthoff D, Quintel M, Ragaller M, Rossaint R, Stuber F, Weiler N, Welte T, Bogatsch H, Hartog C, Loeffler M, Reinhart K. Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med. 2007;17:606–618. doi: 10.1007/s00134-006-0517-7. - DOI - PubMed
    1. Brunbuisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier JC, Offenstadt G, Regnier B. Incidence, risk-factors, and outcome of severe sepsis and septic shock in adults - a multicenter prospective-study in intensive-care units. JAMA. 1995;17:968–974. doi: 10.1001/jama.1995.03530120060042. - DOI - PubMed
    1. Heublein S, Hartmann M, Hagel S, Hutagalung R, Brunkhorst FM. Epidemiology of sepsis in German hospitals derived from administrative databases. Infection. 2013;17:S71.
    1. Carrol ED, Thomson AP, Hart CA. Procalcitonin as a marker of sepsis. Int J Antimicrob Agents. 2002;17:1–9. - PubMed
    1. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;17:515–518. doi: 10.1016/0140-6736(93)90277-N. - DOI - PMC - PubMed

Publication types