From the Guidelines
Procalcitonin (PCT) should be used as a supportive tool in diagnosing and managing sepsis, particularly in guiding antibiotic therapy decisions, as it has been shown to reduce antibiotic duration and improve mortality in critically ill patients. PCT levels rise significantly in bacterial infections, with levels above 0.5 ng/mL suggesting bacterial infection, and levels above 2 ng/mL strongly indicating sepsis 1. Serial PCT measurements are useful for monitoring treatment response and determining when to safely discontinue antibiotics, with a decrease of 80% from peak or a fall below 0.5 ng/mL indicating infection control and potentially supporting antibiotic discontinuation 1.
Some key points to consider when using PCT in sepsis management include:
- PCT levels can be elevated in non-infectious conditions, such as severe trauma, major surgery, and some cancers, potentially causing false positives 1
- PCT should not be used in isolation, but rather interpreted alongside clinical assessment, other laboratory findings, and patient context 1
- The use of PCT in guiding antibiotic therapy decisions has been shown to reduce antibiotic duration by 1-2 days and improve mortality in critically ill patients, as demonstrated in a recent meta-analysis of 11 RCTs involving 4,482 patients 1
- PCT testing is most effective when incorporated into comprehensive sepsis protocols that include timely antibiotic administration, source control, and appropriate supportive care 1
In terms of specific guidelines, the Society of Critical Care Medicine and the Infectious Diseases Society of America recommend against routine use of biomarkers, including PCT, in the setting of sepsis and septic shock, but suggest that PCT may be useful in guiding antibiotic discontinuation in patients with low to intermediate clinical probability of bacterial infection 1. Additionally, a recent systematic review and meta-analysis found that PCT had a higher diagnostic accuracy and specificity than C-reactive protein (CRP) for diagnosing sepsis in adult patients 1.
Overall, PCT is a valuable tool in the diagnosis and management of sepsis, particularly in guiding antibiotic therapy decisions, and should be used in conjunction with clinical assessment and other laboratory findings to improve patient outcomes.
From the Research
Role of Procalcitonin in Diagnosing Sepsis
- Procalcitonin (PCT) is a biomarker that can help differentiate between infectious and non-infectious systemic inflammatory response syndrome (SIRS) in adults 2.
- PCT has been shown to be a useful tool in diagnosing late-onset neonatal sepsis, bacterial meningitis, and other forms of organ-related bacterial infections 2.
- A study found that PCT can accurately differentiate culture-negative sepsis from non-infectious SIRS, contributing to early diagnosis and effective management of these conditions 3.
Procalcitonin-Guided Antibiotic Therapy
- PCT-guided antibiotic therapy has been shown to be beneficial in reducing antibiotic usage and costs, as well as improving patient outcomes 4, 5.
- A systematic review and network meta-analysis found that PCT-guided antibiotic cessation strategies shortened antibiotic treatment and lowered mortality in sepsis patients 5.
- PCT-guided strategies have been found to be safe and effective in guiding antibiotic discontinuation in critically ill adults with sepsis, without increasing the risk of recurrence 5.
Clinical Applications of Procalcitonin
- PCT has good discriminatory properties to differentiate between bacterial and viral inflammations, and can provide rapidly available results 6.
- PCT can aid in risk stratification and prognostication, influencing appropriate use of healthcare resources and therapeutic options 6.
- PCT kinetics over time can improve the monitoring of critically ill patients with sepsis, influencing decisions regarding de-escalation of antibiotics 6.
- PCT can help guide antibiotic use in patients with respiratory infection and sepsis, limiting initiation and shortening treatment duration 6.