Procalcitonin: A promising tool or just another overhyped test?

Abstract

Sepsis is the leading cause of death worldwide. Timely administration of antibiotics is recognized as the cornerstone in the management of sepsis. However, inappropriate use of antibiotics may lead to adverse effects and the selection of drug-resistant pathogens. Microbiological cultures remain the gold standard to diagnose infection despite their low sensitivity and the intrinsic delay to obtain the results. Certain biomarkers have the benefit of rapid turnover, potentially providing an advantage in timely diagnosis leading to accurate treatment. Over the last few decades, there is an ongoing quest for the ideal biomarker in sepsis. Procalcitonin (PCT), when used alone or alongside additional clinical information, has shown to be a promising tool to aid in the diagnosis and management of patients with sepsis. In February 2017, the Food and Drug Administration (FDA) approved the use of PCT to guide antibiotic treatment in lower respiratory tract infections and sepsis. Despite a good negative predictive value for bacterial infection, the utility of PCT-guided antibiotic initiation is conflicting at best. On the other hand, the use of PCT-guided antibiotic discontinuation has shown to reduce the duration of antibiotic use, the associated adverse effects, and to decrease the overall mortality. The current review discusses the history and pathophysiology of procalcitonin, synthesizes its utility in the diagnosis and management of sepsis, highlights its limitations and compares it with other biomarkers in sepsis.

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

“…However, the optimal use of PCT-guided antibiotic therapy has been discussed for a long time [ 19 , 20 ]. Many reviews and meta-analyses concluded that PCT is a good indicator of bacterial infection [ 21–24 ] and that overall antibiotics exposure can be reduced safely [ 25–36 ].…”

Procalcitonin as a biomarker of bacterial infection in critically ill patients admitted with suspected Sepsis in Intensive Care Unit of a tertiary care hospital

“…PCT levels increase in bacterial infections from an extrathyroidal origin and rise early in course of infection, therefore making it useful biomarker for decision making regarding initiation of antibiotic therapy as results of blood culture are not available immediately. 15 One hundred and twenty six blood specimens of critically ill patients admitted with suspicion of sepsis in intensive care unit were analyzed for PCT, CRP, TLC and lactate and compared with blood culture results as gold standard for bacterial infection. Majority of patients with positive blood culture were male (73%).…”

A bibliometric analysis of the application of procalcitonin in patients in the intensive care unit

“…When there is bacterial infection, various tissues outside the thyroid can be induced to express calcitonin I, leading to PCT being released into the blood in large quantities (9). The process is divided into 2 phases: the first is the early phase (2-3 h after infection), which is mainly caused by bacterial infection itself or endotoxin stimulation; and the latter is the delayed phase, which is mainly caused by inflammatory factors (such as TNF-α, IL-1, IL-2, IL-6) which initiate a large amount of synthesis and release of PCT in various tissues outside the thyroid (10). The delayed phase is also an important reason for the peak of PCT within 12-24 h after systemic bacterial infection (11).…”