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Review
. 2020 Dec;6(2):201-214.
doi: 10.1007/s41030-020-00123-8. Epub 2020 Jul 16.

Procalcitonin for Antibiotic Prescription in Chronic Obstructive Pulmonary Disease Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective

Ken Chen  1 , Katherine A Pleasants  2 , Roy A Pleasants  3 , Tatsiana Beiko  4 , Ronald G Washburn  2 , Zhiheng Yu  5 , Suodi Zhai  5 , M Bradley Drummond  6
Affiliations
Review

Procalcitonin for Antibiotic Prescription in Chronic Obstructive Pulmonary Disease Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective

Ken Chen et al. Pulm Ther. 2020 Dec.

Abstract

The 2020 Global Initiative for Obstructive Lung Disease report indicates that the blood biomarker procalcitonin (PCT) may assist in decision-making regarding the initiation of antibiotics for chronic obstructive pulmonary disease (COPD) exacerbations. PCT is an acute-phase reactant that increases in response to inflammation and infection, and has been studied in various bacterial infections for initiation and de-escalation of antibacterials. The purpose of this systematic review and meta-analysis was to evaluate the strength of the data on the use of PCT to guide antibiotic prescription in COPD exacerbations. Among the randomized clinical trials included in our meta-analysis, almost all of which were conducted exclusively in the hospital setting. PCT was found to decrease overall antibiotic exposure in COPD exacerbations by 2.01 days (p = 0.04), while no apparent effects were found on clinical outcomes (length of hospital stay, p = 0.88; treatment failure p = 0.51; all-cause mortality p = 0.28). However, the majority of blood PCT levels in COPD exacerbations were below the manufacturer-recommended cutoff for antibiotics, and the use of this marker was associated with worse outcomes in the intensive care setting. Further, based on additional sensitivity analysis excluding studies with high risk of bias or with converted outcome value, the effect of PCT on antibiotic duration in RCTs was no longer significant (MD = -1.88 days, 95% CI [-3.95, 0.19] days, p = 0.08, and MD = -1.72 days, 95% CI [-4.28, 0.83] days, p = 0.19, respectively). Our review and analysis does not support the use of PCT to guide antibiotic prescription in COPD exacerbations.

Keywords: Chronic obstructive pulmonary disease; Exacerbation; GOLD report; Procalcitonin.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study screening
Fig. 2
Fig. 2
Risk of bias of included randomized controlled trials for PCT in COPD exacerbations
Fig. 3
Fig. 3
Forest plot of the effects of PCT-based protocol versus standard treatment on length of antibiotic treatment
See this image and copyright information in PMC

References

    1. Global Initiative for Chronic Obstructive Lung Disease Inc. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2020 report. 2020. https://www.goldcopd.org. - PubMed
    1. Chang CH, Tsao KC, Hu HC, et al. Procalcitonin and C-reactive protein cannot differentiate bacterial or viral infection in COPD exacerbation requiring emergency department visits. Int J Chron Obstruct Pulmon Dis. 2015;10:767–774. doi: 10.2147/COPD.S76740. - DOI - PMC - PubMed
    1. Clark TW, Medina MJ, Batham S, et al. C-reactive protein level and microbial aetiology in patients hospitalised with acute exacerbation of COPD. Eur Respir J. 2015;45(1):76–86. doi: 10.1183/09031936.00092214. - DOI - PubMed
    1. Mathioudakis AG, Chatzimavridou-Grigoriadou V, Corlateanu A, et al. Procalcitonin to guide antibiotic administration in COPD exacerbations: a meta-analysis. Eur Respir Rev. 2017;26(143):160073. doi: 10.1183/16000617.0073-2016. - DOI - PMC - PubMed
    1. Ni W, Bao J, Yang D, et al. Potential of serum procalcitonin in predicting bacterial exacerbation and guiding antibiotic administration in severe COPD exacerbations: a systematic review and meta-analysis. Infect Dis (Lond) 2019;51(9):639–650. doi: 10.1080/23744235.2019.1644456. - DOI - PubMed

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