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Evidence summaries

Effectiveness and Safety of Procalcitonin Evaluation for Reducing Mortality in Adults with Sepsis

Use of procalcitonin for early diagnosis and guiding of antimicrobial therapy may not be effective for reducing mortality or duration of antimicrobial therapy in patients with septic conditions. Level of evidence: "C"

Comment: The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment in half of the studies and lack of blinding) and by imprecise results (wide confidence intervals).

Summary

A Cochrane review [Abstract] 1 included 10 studies with a total of 1 215 subjects. Serum procalcitonin (PCT) evaluation has been proposed for early diagnosis and accurate staging and to guide decisions regarding patients with sepsis, severe sepsis and septic shock. No significant differences in mortality at longest follow-up, at 28 days, at ICU discharge, and at hospital discharge (table T1). However, mean time receiving antimicrobial therapy in the intervention groups was 1.28 days shorter. No primary study has analysed the change in antimicrobial regimen from a broad to a narrower spectrum.

PCT versus non-PCT (standard care or CRP) for reducing mortality in adult patients with sepsis

OutcomeRelative effect(95% CI)Risk with control - Non-PCT (standard care or CRP)Risk with intervention - PCT (95 % CI)No of participants(studies) Quality of evidence
Mortality at longest follow-up0.81(0.65 to 1.01)261 per 1000211 per 1000(169 to 263)1156(10) Low
Mortality at 28 days0.89(0.61 to 1.31)250 per 1000223 per 1000(153 to 328)316(4) Low
Mortality at ICU discharge1.03(0.50 to 2.11)97 per 100099 per 1000(48 to 204)506(3) Low
Mortality at hospital discharge0.98(0.75 to 1.27)199 per 1000195 per 1000(149 to 253)805(7) Moderate
Time receiving antimicrobial therapy (days) - mean (SD)-The mean timereceivingantimicrobialtherapy was8.09 days (SD 1.36)The mean time receiving antimicrobial therapywas 1.28 days lower (1.95 lower to 0.61 lower)313(4) Very low

Clinical comments

Note

Date of latest search: 15 July 2015

References

  • Andriolo BN, Andriolo RB, Salomão R et al. Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock. Cochrane Database Syst Rev 2017;(1):CD010959. [PubMed]

Primary/Secondary Keywords