Procalcitonin Algorithm in Critically Ill Adults with Undifferentiated Infection or Suspected Sepsis. A Randomized Controlled Trial

Shehabi, Yahya; Štěrba, Martin; Garrett, Peter; Rachakonda, Kanaka S; Stephens, Dianne P.; Harrigan, Peter; Walker, Alison; Bailey, Michael; Johnson, Bronwyn; Millis, David H.; Ding, Geoff K A; Peake, Sandra; Wong, Helen; Thomas, Jane; Smith, Kate; Forbes, Loretta; Hardie, Miranda; Micallef, Sharon; Fraser, John F.

doi:10.1164/rccm.201408-1483oc

Cited by 163 publications

(163 citation statements)

References 33 publications

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“…Only one study by Jensen and coworkers was considered to have high risk of bias in terms of selective reporting (46). A recent RCT, not included in Prkno's systematic review, showed that PCT-guided therapy in patients with undifferentiated infection or suspected sepsis did not achieve a clinically significant 25% reduction in duration of antibiotic treatment (49). Taken together, PCTguided therapy has no significant adverse consequences.…”

Section: Evidence From Rctsmentioning

confidence: 99%

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Zhang¹,

Smischney²,

Zhang³

et al. 2016

J. Thorac. Dis.

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Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques. As a consequence, diagnostic criteria for sepsis need regular revision to cope with emerging evidence. This review aims to present the most updated information on diagnosis and early recognition of sepsis. Recommendations for

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Section: Evidence From Rctsmentioning

confidence: 99%

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Zhang¹,

Smischney²,

Zhang³

et al. 2016

J. Thorac. Dis.

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“…We referred to 9 RCT reports during our meta‐analysis on this topic 78, 79, 80, 81, 82, 83, 84, 85, 86. No significant differences were observed between the intervention and control groups with respect to ICU stay time, hospitalization period, 60‐day mortality rate, and 90‐day mortality rate.…”

Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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“…In Indonesia research on the use of the parameters of procalcitonin and CRP in patients with sepsis is still very limited, in Makassar has never done research on the parameters of procalcitonin and CRP in patients with sepsis, therefore this research becomes important to know the effective management of sepsis patients (Lopez et al, 2011;Shehabi et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin and C-Reactive Protein as a Predictor of Organ Dysfunction and Outcome of Sepsis and Septic Shock Patients in Intensive Care Unit

Arif¹,

Suyata²,

Gaus³

et al. 2017

GJHS

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Background and Objective: Sepsis is a potentially life-threatening disorder in ICU. The worst complication is organ dysfunction and mortality. Procalcitonin (PCT) and C-Reactive Protein (CRP) had been proposed as biomarker and predictor for diagnosis, prognosis, and patient deterioration in sepsis and septic shock patients. To know whether PCT and CRP can be used as a predictor of organ dysfunction and outcome in sepsis and septic shock patients in ICU.Materials and Methods: Data were cohort retrospectively analyzed in 35 sepsis (45.5%) and 42 septic shock patients (54.5%) admitted to ICU Dr. Wahidin Sudirohusodo General Hospital (January 2014 -December 2015). Data were analyzed using Chi-Square test, Pearson Correlation, and Spearman-Rho Correlation test.Results: Total of 77 patients met the inclusion criteria. Cut-off point in predicting organ dysfunction in sepsis and septic shock was significantly higher in PCT (45.7ng/mL) with 76.6% sensitivity and 70.0% specificity, while CRP was 145.75 mg/mL with 70.2% sensitivity and 56.7% specificity. There was a positive correlation of PCT (0.492 [p=0.000]) and CRP (0.336 [p=0.003]) to organ dysfunction reflected on SOFA score using the Pearson Correlation test (p<0.01 statistically significant). Based on Spearman-Rho Correlation test, correlation of PCT (0.191 [p=0.097]) and CRP (0.110 [p=0.340]) to outcome in day-7 was positive but not statistically significant (p≥0.01). While in day-28, there was positive correlation 0.553 (p=0.001) for PCT, 0.460 (p=0.006) for CRP, and statistically significant (p<0.01).Conclusions: Procalcitonin and CRP can be used as a predictor of organ dysfunction and outcome in sepsis and septic shock patients.Keywords: CRP, procalcitonin, sepsis, outcome, organ dysfunction, septic shock Significant StatementSepsis is a major cause of mortality and morbidity in critically ill patients. Procalcitonin is a prohormone of calcitonin contained in the human body. In sepsis, increased levels of procalcitonin in the blood has a significant value that can be used as a biomarker of sepsis. Compared with other sepsis biomarkers such as CRP, procalcitonin levels are more sensitive and the most rapid rise after exposure to the infection. In another study, the level of invasion of microorganisms in sepsis provides rhythm correlation with increased levels of procalcitonin blood. Provision of appropriate antibiotic therapy will reduce levels of procalcitonin in sepsis, but antibiotics are not appropriate to raise the levels. The high rate of mortality in sepsis indicates the need for action and research to reduce this mortality, one of them with early diagnosis and management of sepsis. In Indonesia research on the use of the parameters of procalcitonin and CRP in patients with sepsis is still very limited, in Makassar has never done research on the parameters of procalcitonin and CRP in patients with sepsis, therefore, this study aims to determine whether the PCT and CRP can be used as a predictor of organ dysfunction and outcomes of patients with s...

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Procalcitonin Algorithm in Critically Ill Adults with Undifferentiated Infection or Suspected Sepsis. A Randomized Controlled Trial

Abstract: In critically ill adults with undifferentiated infections, a PCT algorithm including 0.1 ng/ml cut-off did not achieve 25% reduction in duration of antibiotic treatment. Clinical trial registered with http://www.anzctr.org.au (ACTRN12610000809033).

Cited by 163 publications

References 33 publications

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

Procalcitonin and C-Reactive Protein as a Predictor of Organ Dysfunction and Outcome of Sepsis and Septic Shock Patients in Intensive Care Unit

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