Furthermore, site-of-care decisions can be improved (e.g., early discharge or escalation of care) by an early risk stratification and the provision of prognostic information (8). This statement was also confirmed by a retrospective cohort study of Broyles et al. Testing.com [Internet]. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. ; 2015 Feb [cited 2022 Apr 19]; [about 2 screens]. Numerous biomarkers, which reflect the complex pathophysiology of sepsis, have been identified and evaluated in regard to their prognostic value. The Role of Procalcitonin in Diagnosis of Sepsis and Antibiotic - AACC Frontiers | High Serum Procalcitonin Concentrations in Patients With PCT has good discriminatory properties to differentiate between bacterial and viral inflammations with rapidly available results. Kenilworth (NJ): Merck & Co. Inc.; c2022. Chemistry: Procalcitonin; [updated 2020 Dec 7; cited 2022 Apr 19]; [about 4 screens]. This in turn, has not only a high impact on decisions regarding treatment of patients with suspected infections or sepsis (20), but can also influence the duration of antibiotic treatment courses. Procalcitonin-guided antibiotic treatment in patients with positive blood cultures: A patient-level meta-analysis of randomized trials. Initial data indicate that PCT levels are unaffected by patient use of nonsteroidal anti-inflammatory agents or glucocorticoids. There is thus much potential to optimizing antibiotic treatment through more reliable diagnosis and better management of antibiotic therapy. Use of plasma procalcitonin levels as an adjunct to clinical microbiology. Kopterides P, Siempos II, Tsangaris I, Tsantes A, Armaganidis A. Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and meta-analysis of randomized controlled trials. Procalcitonin guidance was associated with a 2.4-day reduction in antibiotic use (95% CI, 2.15 to 2.71 days).2, Procalcitonin testing can also be used to guide discontinuation of antibiotics in severely ill adults. Muller B, Becker KL, Schachinger H, et al. In this respect, PCT has shown promising results for the treatment of patients with sepsis. PCT cut-offs of <0.5 g/L or a decrease of 8090% from the peak level were considered to indicate recovery and in such cases discontinuation of antibiotic treatment was favorable. Herein, biomarkers have been shown to improve infection diagnosis, help in early risk stratification and provide prognostic information which helps optimizing therapeutic decisions (antibiotic stewardship). Heredia-Rodriguez M, Bustamante-Munguira J, Fierro I, et al. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Hence, PCT may be used to support clinical decisions regarding the initiation or discontinuation of antibiotic therapy [5,6]. The Procalcitonin-guided Antibiotics in Respiratory Infections (PARI) project in general practice - a study protocol. Use of plasma procalcitonin levels as an adjunct to clinical microbiology. A meta-analysis of 11 studies including 4,482 adult patients in the intensive care unit found that using procalcitonin testing to guide antibiotic discontinuation reduced mortality (odds ratio = 0.89; 95% CI, 0.8 to 0.99); the effect was nearly identical for patients with and without sepsis.3 Duration of antibiotic therapy decreased by 1.19 days (95% CI, 0.66 to 1.73 days) overall and by 1.22 days (95% CI, 0.62 to 1.82 days) in patients with sepsis.3, Procalcitonin can be elevated in several other disease states, potentially leading to unnecessary antibiotic use in settings outside of respiratory tract infections. The use of PCT is evolving in the management of sepsis and several interventional studies and systematic reviews have analyzed and summarized the effects of PCT-guided strategies on antibiotic use and health outcomes. 1 Procalcitonin testing. Current clinical laboratory methods in the diagnosis of bacterial infections are either non-specific or require longer turnaround times. Laukemann S, Kasper N, Kulkarni P, et al. Procalcitonin in intensive care units: the PRORATA trial. The clinical utility of serum PCT levels continues to evolve [7]. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. In the intensive care unit at our institution, a fall in the level of PCT to 0.1 ng/mL is used to signify the end of bacterial invasion and that it is safe to discontinue antibiotic therapy [33]. Moreover, it should be noted that some non-infectious disorders, such as C-cell carcinoma or trauma, can lead to a systemic inflammation resulting in elevated PCT levels. Procalcitonin: Uses in the Clinical Laboratory for the Diagnosis of de Jong E, van Oers JA, Beishuizen A, et al. Highly sensitive PCT assays are needed to reliably diagnose CAP and non-CAP lower respiratory tract infections (RTIs) [1,17]. But a procalcitonin test does give you important information about your risk for sepsis, so you can start treatment sooner, if needed, and avoid more serious illness. Calcitonin's only recognized biologic activity is to lower the serum calcium concentration by inhibiting bone resorption [7]. the contents by NLM or the National Institutes of Health. When PCT is used to guide diagnostic and therapeutic decisions in patients with infections in medical practice, two important issues need to be considered in order to optimize diagnostic accuracy and patient safety: the functional assay sensitivity and cutoff ranges. However, the PCT levels should always be interpreted in a context with clinical presentation, medical history, physical examination and if available microbiological assessment of the patients (18). Thus, PCT provides important additional information, which are able to supplement clinical and diagnostic parameters (19). Procalcitonin Monitoring as a Guide for Antimicrobial Therapy: A Review of Current Literature. Biomarker-guided de-escalation of empirical therapy is associated with lower risk for adverse outcomes. The interventional non-inferiority proACT trial revealed low adherence rates to the PCT protocol, indicating a shortcoming of experience in the use of PCT as well as in its interpretation in a clinical context. We've shared how PCT can help reduce antibiotic exposure and bolster antibiotic stewardship programs . According to the current body of evidence an international expert group recently published a consensus algorithm for the PCT use in patients with suspected bacterial infections. Mayo Foundation for Medical Education and Research; c19952022. The primary objective of this study was to determine the correlation between procalcitonin values and illness severity by evaluating the degree of end organ dysfunction using the Sequential Organ Failure Assessment score, length of stay and the severity of sepsis (sepsis alone vs. septic shock), The hypothesis that procalcitonin values would be . The analysis of retrospective data from two independent US critical care institutions indicated a high prognostic power for the 72-hour PCT kinetics for predicting sepsis mortality (50). High PCT concentrations are commonly found in bacterial infection, in contrast to much lower levels in viral infection.However, even though PCT is virtually undetectable (less than 0.1 ng/mL) in healthy individuals, elevated serum PCT concentrations are not always specific for sepsis. Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Types of biomarkers and examples of their potential use. Finally, the most useful application is the use of sequential PCT levels to determine when there is no longer a need for antibacterial therapy [7,19]. Procalcitonin is a biomarker produced by the body that is elevated in times of systemic inflammation, particularly when due to bacterial infection. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. Procalcitonin for Diagnosis, Risk Assessment, and Prognosis of - AAFP Yo PH, Cheng HY, et al. Gac AC, Parienti JJ, Chantepie S, et al. in 2007, included 18 studies with 2,097 critically ill patients and showed a median sensitivity and specificity of 74% for PCT. For example, a procalcitonin test can help tell the difference between bacterial and viral pneumonia. Sepsis and Septic Shock; [reviewed 2021 Sep; cited 2022 Apr 19]; [about 5 screens]. What exactly is PCT? The high PCT levels produced during infection are not followed by a parallel . Efficacy and Safety of Procalcitonin Guidance in Patients With Suspected or Confirmed Sepsis: A Systematic Review and Meta-Analysis. A growing body of evidence supports the use of PCT as a marker to improve the diagnosis of bacterial infections and to guide antibiotic therapy. A more recently published international expert consensus, recommended PCT cut-off levels for critically ill patients in order to estimate the probability of bacterial infections and therefore, improve initial clinical assessment (Figure 2) (21). Data about the use of PCT in immunosuppressed patients including patients with HIV, cystic fibrosis, pancreatitis, trauma, pregnancy and high volume transfusion are very low. Procalcitonin measurement is a blood test used to aid in the diagnosis of bacterial lower respiratory tract infections and guide initiation of antibiotic therapy.1 Procalcitonin testing may also be used to reduce adverse effects in adults with respiratory tract infections or sepsis and guide discontinuation of antibiotic therapy in patients with sepsis.24, Most laboratories can produce a procalcitonin result within two hours.5 In patients with community-acquired pneumonia (CAP), procalcitonin findings can help distinguish bacterial from viral pathogens, although accuracy is limited.1 In a meta-analysis of 12 studies including 2,408 adults with CAP, procalcitonin testing had a sensitivity of 0.55 (95% CI, 0.37 to 0.71) and specificity of 0.76 (95% CI, 0.62 to 0.86) for bacterial infection.6 In a meta-analysis of 25 studies including 2,864 children, procalcitonin testing had a sensitivity of 0.64 (95% CI, 0.53 to 0.74) and specificity of 0.72 (95% CI, 0.64 to 0.79) for bacterial pneumonia.7, Different organisms may cause different procalcitonin elevations. Morgenthaler NG, Struck J, Fischer-Schulz C, Seidel-Mueller E, Beier W, Bergmann A. PCT is a protein consisting of 116 amino acids and can be detected in the blood in response to bacterial infection with systemic inflammatory reactions. Clinical risk scores, such as APACHE or SAPS II, are only validated when used with admission values and are also limited by practicality issues (35,36). This was reflected in a large interventional study, which showed that survival was not improved by a PCT-guided diagnostic and therapeutic management escalation. The https:// ensures that you are connecting to the Although PCT is the prohormone for calcitonin, its biologic activities are distinctly different [9]. Further, PCT adds to risk stratification and prognostication, which may influence appropriate use of health-care resources and therapeutic options. Inclusion in an NLM database does not imply endorsement of, or agreement with, HHS Vulnerability Disclosure, Help Manian FA. Procalcitonin (ProCT) covers these features better as compared to other, more commonly used biomarkers, and thus, the current hype on ProCT has a solid scientific basis. PCT kinetics also showed a correlation with severity of illness (20). The feasibility and safety of these algorithms was prospectively investigated and repetitively validated in multiple randomized control trials by independent groups (Table 2). In this context, the use of the host-response and blood infection marker procalcitonin (PCT) has gained much attention and has already been approved for guidance of antimicrobial therapies in patients with respiratory infection and sepsis (10-16). A randomized trial analyzing 1,200 critically ill patients in nine multidisciplinary intensive care units in Denmark, demonstrated that therapy escalation did not improve outcome when PCT-algorithms were used (45). This may help you get the right treatment quickly before your condition worsens. Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J. Clinical and economic impact of procalcitonin to shorten antimicrobial therapy in septic patients with proven bacterial infection in an intensive care setting.
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