A 2020 review on the role of procalcitonin in different clinical settings: an update conducted with the tools of the Evidence Based Laboratory Medicine

Abstract

Biomarkers to guide antibiotic treatment decisions have been proposed as an effective way to enhancing a more appropriate use of antibiotics. As a biomarker, procalcitonin (PCT) has been found to have good specificity to distinguish bacterial from non-bacterial inflammations. Decisions regarding antibiotic use in an individual patient are complex and should be based on the pre-test probability for bacterial infection, the severity of presentation and the results of PCT serum concentration. In the context of a high pre-test probability for bacterial infections and/or a high-risk patient with sepsis, monitoring of PCT over time helps to track the resolution of infection and decisions regarding early stop of antibiotic treatment. As outlined by the Evidence Based Laboratory Medicine (EBLM), not only the pre-test probability but also the positive likelihood ratio influence the performance of a test do be really diagnostic. This aspect should be taken into account in the interpretation of the results of clinical trials evaluating the performance of PCT in guiding antibiotic therapy.

Proposal of COVID-19 Clinical Risk Score for the management of suspected COVID-19 cases: a case control study

“…However, in the present study, which compared COVID-19 cases with other febrile illnesses and cases with abnormal images on chest CT, a low level of procalcitonin was evident in patients with COVID-19, whereas the CRP level was elevated. Procalcitonin level is predominantly elevated in bacterial infections [ 28 ]. A substantial number of cases of bacterial infections may be observed in non-COVID-19 patients, and these patients were more likely to have elevated procalcitonin level at an early stage of the disease.…”

How We Treat Fever and Hypotension in Pediatric Hematopoietic Cell Transplant Patients

“…Rapid staging of multi-organ injury (MOI) can help set the tempo of resuscitation and guide downstream management. Further workup should include a blood gas with lactate and procalcitonin as sepsis biomarkers (5,6), comprehensive metabolic panel to assess for progressive renal and hepatic injury, coagulation studies, fibrinogen, and d-dimers to assess for disseminated intravascular coagulopathy (DIC) and repeat CBC to guide potential need for transfusion. Physical exam looking for a potential source of infection should be performed promptly.…”

Prospective Observational Study to Determine Kinetics of Procalcitonin in Hospitalized Children Receiving Antibiotic Therapy for Non-Critical Acute Bacterial Infections

“…In the event that PCT is measured too early in the disease course, it can be falsely low and should be repeated in patients with other signs and symptoms consistent with bacterial infection. In adults, clinical syndromes with the most data supporting use of PCT include sepsis, pneumonia and chronic obstructive pulmonary disease [11,12]. The 2019 Infectious Diseases Society of America (IDSA) Community Acquired Pneumonia guidelines suggest that PCT can be used to decrease duration of therapy for pneumonia but should not be used to determine need to initiate antibiotics in someone with clinical suspicion of pneumonia [12].…”

“…Similarly, the 2016 Surviving Sepsis Campaign guidelines recommend the use of PCT for antibiotic de-escalation but not for determining need to initiate antibiotics [13]. There are fewer data to support the use of PCT use in meningitis or in infectious complications of trauma, burns and pancreatitis [11]. Recent studies have evaluated the role of PCT in identifying bacterial infection in children with pneumonia, musculoskeletal infection, central line and fever and urinary tract infections, with varying utility of PCT to predict bacterial vs. non-bacterial infection [14][15][16][17][18].…”