https://doi.org/10.4081/itjm.2021.1438

Procalcitonin in clinical practice: from diagnosis of sepsis to antibiotic therapy

Vol. 15 No. 1 (2021)
Published: 18 March 2021
COVID-19, procalcitonin, sepsis, antimicrobial therapy.
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Authors

Gabriele Cioni
gabrielec.83@gmail.com
https://orcid.org/0000-0002-8918-9836
Emergency Department, SS Cosma and Damiano Pescia Hospital, USL Toscana Centro, Pescia (PT), Italy.
Jessica Canini
San Luca Hospital, USL Toscana Nord Ovest, Lucca, Italy.
Filippo Pieralli
AOU Careggi, Florence, Italy.

A diagnostic algorithm that allows for the rapid identification of sepsis and possibly guides the appropriate antimicrobial therapy application is the cornerstone to obtaining effective treatment and better results. The use of emerging surrogate markers could significantly improve clinical practice, but the validity and clinical utility have been proved only for very few of them, and their availability in clinical routine is limited. For this purpose, numerous scientific evidence has indicated procalcitonin as a marker linked to sepsis and its evolution. This review aims to retrace the main evidence relating to the use of procalcitonin in sepsis. We analyzed the primary studies in the literature and the existing meta-analysis evaluating the behavior of procalcitonin as a marker of bacterial sepsis, its prognostic power, and its ability to influence antibiotic therapy. Recent evidence has suggested that procalcitonin could be an efficient marker for diagnosing sepsis and its therapeutic management in many types of patients. The choice of the appropriate timing to initiate and suspend antibiotic therapy, with obvious clinical advantages, the favorable effects could also include reducing health costs, both avoiding the administration of inappropriate antibiotic therapies, and reducing the duration of hospitalization. Moreover, limited studies reported high procalcitonin levels in coronavirus disease 2019 patients with a worse prognosis. Despite the considerable evidence in favor of the potential of procalcitonin as an index for managing septic patients, there are conflicting data that deserve specific and detailed studies.

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Citations

Crossref
Scopus
Google Scholar
Europe PMC
Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-10. DOI: https://doi.org/10.1097/00003246-200107000-00002
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546-54. DOI: https://doi.org/10.1056/NEJMoa022139
Marshall JC, Reinhart K. Biomarkers of sepsis. Crit Care Med 2009;37:2290–8. DOI: https://doi.org/10.1097/CCM.0b013e3181a02afc
Liu Y, Hou J, Li Q, et al. Biomarkers for diagnosis of sepsis in patients with systemic inflammatory response syndrome: a systematic review and meta-analysis. Springerplus 2016;2091. DOI: https://doi.org/10.1186/s40064-016-3591-5
Biomarkers Definitions Working Group. Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther 2001;69:89-95. DOI: https://doi.org/10.1067/mcp.2001.113989
Maruna P, Nedělníková K, Gürlich R. Physiology and genetics of procalcitonin. Physiol Res 2000;49:57-61.
Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab 1994;79:1605-8.
Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993;341:515-8. DOI: https://doi.org/10.1016/0140-6736(93)90277-N
Giamarellos-Bourboulis E, Grecka A, Scarpa N, et al. Procalcitonin: A marker to clearly differentiate systemic inflammatory inflammatory response syndrome and sepsis in the critically ill patient? Intensive Care Med 2002;28:1351-6. DOI: https://doi.org/10.1007/s00134-002-1398-z
Harbarth S, Holeckova K, Froidevaux C, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 2001;164:396-402. DOI: https://doi.org/10.1164/ajrccm.164.3.2009052
Wanner G, Keel M, Steckholzer U, et al. Relationship between procalcitonin plasma levels and severity of injury, sepsis, organ failure, and mortality in injured patients. Crit Care Med 2000;28:950-7. DOI: https://doi.org/10.1097/00003246-200004000-00007
Brunkhorst F, Wegscheider K, Forycki Z, et al. Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock. Intensive Care Med 2000;26:S148-52. DOI: https://doi.org/10.1007/BF02900728
Balci C, Sungurtekin H, Gu¨rses E, et al. Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care 200;7:85-90. DOI: https://doi.org/10.1186/cc1843
Luzzani A, Polati E, Dorizzi R, et al. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med 2003;31:1737-41. DOI: https://doi.org/10.1097/01.CCM.0000063440.19188.ED
Endo S, Aikawa N, Fujishima S, et al. Usefulness of procalcitonin serum level for the discrimination of severe sepsis from sepsis: A multicenter prospective study. J Infect Chemother 2008;14:244-9. DOI: https://doi.org/10.1007/s10156-008-0608-1
Tsangaris I, Plachouras D, Kavatha D, et al. Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay. BMC Infect Dis 2009;9:213. DOI: https://doi.org/10.1186/1471-2334-9-213
Meynaar I, Droog W, Batstra M, et al. In critically ill patients, serum procalcitonin is more useful in differentiating between sepsis and SIRS than CRP, Il-6, or LBP. Crit Care Res Pract 2011;2011:594-645. DOI: https://doi.org/10.1155/2011/594645
Al-Nawas B, Krammer I, Shah P. Procalcitonin in diagnosis of severe infections. Eur J Med Res 1996;1:331-3.
De Werra I, Jaccard C, Betz Corradin S, et al. Cytokines, nitrite/nitrate, soluble tumor necrosis factor receptors, and procalcitonin concentrations: Comparisons in patients with septic shock, cardiogenic shock, and bacterial pneumonia. Crit Care Med 1997;25:607-13. DOI: https://doi.org/10.1097/00003246-199704000-00009
Benoist J, Mimoz O, Assicot M, et al. Serum procalcitonin, but not C-reactive protein, identifies sepsis in trauma patients. Clin Chem 1998;44:1778-9. DOI: https://doi.org/10.1093/clinchem/44.8.1778
Whang K, Steinwald P, White J, et al. Serum calcitonin precursors in sepsis and systemic inflammation. J Clin Endocrinol Metab 1998;83:3296-301. DOI: https://doi.org/10.1210/jc.83.9.3296
Bossink A, Groeneveld A, Thijs L. Prediction of microbial infection and mortality in medical patients with fever: Plasma procalcitonin, neutrophilic elastase-alpha-antitrypsin, and lactoferrin compared with clinical variables. Clin Infect Dis 1999;29:398-407. DOI: https://doi.org/10.1086/520222
Rothenburger M, Markewitz A, Lenz T, et al. Detection of acute phase response and infection. The role of procalcitonin and C-reactive protein. Clin Chem Lab Med 1999;37:275-9. DOI: https://doi.org/10.1515/CCLM.1999.048
Adamik B, Kubler-Kielb J, Golebiowska B, et al. Effect of sepsis and cardiac surgery with cardiopulmonary bypass on plasma level of nitric oxide metabolites, neopterin, and procalcitonin: Correlation with mortality and postoperative complications. Intensive Care Med 2000;26:1259-67.
Aouifi A, Piriou V, Bastien O, et al. Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med 2000;28:3171-6. DOI: https://doi.org/10.1097/00003246-200009000-00008
Baykut D, Schulte-Herbruggen J, Krian A. The value of procalcitonin as an infection marker in cardiac surgery. Eur J Med Res 2000;5:530-6.
Boeken U, Feindt P, Micek M, et al. Procalcitonin (PCT) in cardiac surgery: Diagnostic value in systemic inflammatory response syndrome (SIRS), sepsis and after heart transplantation (HTX). Cardiovasc Surg 2000;8:550-4. DOI: https://doi.org/10.1016/S0967-2109(00)00070-3
Cheval C, Timsit J, Garrouste-Orgeas M, et al. Procalcitonin (PCT) is useful in predicting the bacterial origin of an acute circulatory failure in critically ill patients. Intensive Care Med 2000;26:S153-8. DOI: https://doi.org/10.1007/s001340051135
Oberhoffer M, Russwurm S, Bredle D, et al. Discriminative power of inflammatory markers for prediction of tumor necrosis factor-a and interleukin-6 in ICU patients with systemic inflammatory response syndrome (SIRS) or sepsis at arbitrary time points. Intensive Care Med 2000;26:S170-4. DOI: https://doi.org/10.1007/BF02900732
Suprin E, Camus C, Gacouin A, et al. Procalcitonin: a valuable indicator of infection in a medical ICU? Intensive Care Med 2000;26:1232-8. DOI: https://doi.org/10.1007/s001340000580
Ugarte H, Silva E, Mercan D, et al. Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med 1999;27:498-504. DOI: https://doi.org/10.1097/00003246-199903000-00024
Dorge H, Schondube FA, Dorge P, et al. Procalcitonin is a valuable prognostic marker in cardiac surgery but not specific for infection. Thorac Cardiovasc Surg 2003;51:322-6. DOI: https://doi.org/10.1055/s-2003-45425
Ruokonen E, Ilkka L, Niskanen M, Takala J. Procalcitonin and neopterin as indicators of infection in critically ill patients. Acta Anaesthesiol Scand 2002;46:398-404. DOI: https://doi.org/10.1034/j.1399-6576.2002.460412.x
Baumgarten R, Pequeriaux N, Van Puyenbroek MJE, Speelberg B. Diagnosis of sepsis by procalcitonin. Ned Tijdschr Klin Chem 2002;27:32-35.
Sudhir U, Venkatachalaiah R, Kumar TA, et al. Significance of serum procalcitonin in sepsis. Indian J Crit Care Med 2011;15:1-5. DOI: https://doi.org/10.4103/0972-5229.78214
Gibot S, Kolopp-Sarda M, Bene M. Plasma level of a triggering receptor expressed on myeloid cells-1: Its diagnostic accuracy in patients with suspected sepsis. Ann Intern Med 2004;141:9-15. DOI: https://doi.org/10.7326/0003-4819-141-1-200407060-00009
Wu CC, Lan HM, Han ST, et al. Comparison of diagnostic accuracy in sepsis between presepsin, procalcitonin, and C-reactive protein: a systematic review and meta-analysis. Ann Intensive Care 2017;7:91. DOI: https://doi.org/10.1186/s13613-017-0316-z
Zhang H, Wang X, Zhang Q, et al. Comparison of procalcitonin and high-sensitivity C-reactive protein for the diagnosis of sepsis and septic shock in the oldest old patients. BMC Geriatr 2017;17:173. DOI: https://doi.org/10.1186/s12877-017-0566-5
Qin DJ, Tang ZS, Chen SL, et al. [Value of combined determination of neutrophil CD64 and procalcitonin in early diagnosis of neonatal bacterial infection]. Zhongguo Dang Dai Er Ke Za Zhi 2017;19:872-6. [in Chinese].
Ljungström L, Pernestig AK, Jacobsson G, et al. Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis. PLoS One 2017;12:e0181704. DOI: https://doi.org/10.1371/journal.pone.0181704
Karon BS, Tolan NV, Wockenfus AM, et al. Evaluation of lactate, white blood cell count, neutrophil count, procalcitonin and immature granulocyte count as biomarkers for sepsis in emergency department patients. Clin Biochem. 2017 May 25. pii: S0009-9120(17)30220-5. DOI: https://doi.org/10.1016/j.clinbiochem.2017.05.014
Heredia-Rodríguez M, Bustamante-Munguira J, Lorenzo M, et al. Procalcitonin and white blood cells, combined predictors of infection in cardiac surgery patients. J Surg Res 2017;212:187-94. DOI: https://doi.org/10.1016/j.jss.2017.01.021
Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care 1999;3:45-50. DOI: https://doi.org/10.1186/cc306
Mu¨ller B, Becker K, Scha¨chinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000;28:977-83. DOI: https://doi.org/10.1097/00003246-200004000-00011
Nargis W, Ibrahim MD, Ahamed BU. Procalcitonin versus C-reactive protein: usefulness as biomarker of sepsis in ICU patient. Int J Crit Illn Inj Sci 2014;4:195-9. DOI: https://doi.org/10.4103/2229-5151.141356
Walsh TL, DiSilvio BE, Hammer C, et al. Impact of procalcitonin guidance with an educational program on management of adults hospitalized with pneumonia. Am J Med 2017 Sep 22. pii: S0002-9343(17)30940-3.
He C, Wang B, Li D, Xu H, Shen Y.Performance of procalcitonin in diagnosing parapneumonic pleural effusions: A clinical study and meta-analysis. Medicine (Baltimore) 2017;96:e7829. DOI: https://doi.org/10.1097/MD.0000000000007829
Çolak A, Yılmaz C, Toprak B, Aktoğu S. Procalcitonin and CRP as biomarkers in discrimination of community-acquired pneumonia and exacerbation of COPD. J Med Biochem 2017;36:122-6. DOI: https://doi.org/10.1515/jomb-2017-0011
Müller B, Harbarth S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007;7:10.
Alba GA, Truong QA, Gaggin HK, et al. Diagnostic and prognostic utility of procalcitonin in patients presenting to the emergency department with dyspnea. Am J Med 2016;129:96-104. DOI: https://doi.org/10.1016/j.amjmed.2015.06.037
Maisel A, Neath SX, Landsberg J, et al. Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (Biomarkers in Acute Heart Failure) trial. Eur J Heart Fail 2012;14:278-86. DOI: https://doi.org/10.1093/eurjhf/hfr177
Le Bel J, Hausfater P, Chenevier-Gobeaux C, et al.; ESCAPED study group. Diagnostic accuracy of C-reactive protein and procalcitonin in suspected community-acquired pneumonia adults visiting emergency department and having a systematic thoracic CT scan. Crit Care 2015;19:366. DOI: https://doi.org/10.1186/s13054-015-1083-6
Müller B, Harbarth S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007;7:10. DOI: https://doi.org/10.1186/1471-2334-7-10
Domínguez-Comesaña E, Estevez-Fernández SM, López-Gómez V, et al. Procalcitonin and C-reactive protein as early markers of postoperative intra-abdominal infection in patients operated on colorectal cancer. Int J Colorectal Dis 2017;32:1771-4. DOI: https://doi.org/10.1007/s00384-017-2902-9
Ko YH, Ji YS, Park SY, et al. Procalcitonin determined at emergency department as an early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi. Int Braz J Urol 2016;42:270-6. DOI: https://doi.org/10.1590/S1677-5538.IBJU.2014.0465
Arai T, Kumasaka K, Nagata K, et al. Prediction of blood culture results by measuring procalcitonin levels and other inflammatory biomarkers. Am J Emerg Med 2014;32:330-3. DOI: https://doi.org/10.1016/j.ajem.2013.12.035
Pieralli F, Corbo L, Torrigiani A, et al. Usefulness of procalcitonin in differentiating Candida and bacterial blood stream infections in critically ill septic patients outside the intensive care unit. Intern Emerg Med 2017;12:629-35. DOI: https://doi.org/10.1007/s11739-017-1627-7
Uzzan B. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and metaanalysis. Crit Care Med 2006;34:1996-2003. DOI: https://doi.org/10.1097/01.CCM.0000226413.54364.36
Tang BM, Eslick GD, Craig JC, et al. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and metaanalysis. Lancet Infect Dis 2007;7:210-7. DOI: https://doi.org/10.1016/S1473-3099(07)70052-X
Jones AE, Fiechtl JF, Brown MD, et al. Procalcitonin test in the diagnosis of bacteremia: a meta-analysis. Ann Emerg Med 2007;50:34-41. DOI: https://doi.org/10.1016/j.annemergmed.2006.10.020
Kopterides P, Siempos II, Tsangaris I, et al. Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med 2010;38:2229-41. DOI: https://doi.org/10.1097/CCM.0b013e3181f17bf9
Heyland D, Johnson A, Reynolds S, Muscedere J. Procalcitonin for reduced antibiotic exposure in the critical care setting: A systematic review and an economic evaluation. Crit Care Med 2011;39:1792-9. DOI: https://doi.org/10.1097/CCM.0b013e31821201a5
Schuetz P, Chiappa V, Briel M, Greenwald JL. Procalcitonin algorithms for antibiotic therapy decisions: A systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med 2011;171:1322-31. DOI: https://doi.org/10.1001/archinternmed.2011.318
Wilke M, Grube R, Bodmann K. The use of a standardized PCT-algorithm reduces costs in intensive care in septic patients - A DRG-based simulation model. Eur J Med Res 2011;16:543-8. DOI: https://doi.org/10.1186/2047-783X-16-12-543
Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 2013;13:426-35.
Hu L, Shi Q, Shi M, et al. Diagnostic Value of PCT and CRP for detecting serious bacterial infections in patients with fever of unknown origin: a systematic review and meta-analysis. Appl Immunohistochem Mol Morphol 2017;25:e61-9. DOI: https://doi.org/10.1097/PAI.0000000000000552
Schuetz P, Wirz Y, Sager R, et al. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. Lancet Infect Dis 2018;18:95-107. DOI: https://doi.org/10.1016/S1473-3099(17)30592-3
Selberg O, Hecker H, Martin M, et al. Discrimination of sepsis and systemic inflammatory response syndrome by determination of circulating plasma concentrations of procalcitonin, protein complement 3a, and interleukin-6. Crit Care Med 2000;28:2793-8. DOI: https://doi.org/10.1097/00003246-200008000-00019
Castelli G, Pognani C, Meisner M, et al. Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction. Crit Care 2004;8:R234-42. DOI: https://doi.org/10.1186/cc2877
Reith H, Mittelko¨tter U, Wagner R, et al. Procalcitonin (PCT) in patients with abdominal sepsis. Intensive Care Med 2000;26:S165-9. DOI: https://doi.org/10.1007/s001340051137
Sager R, Wirz Y, Amin D, et al. Are admission procalcitonin levels universal mortality predictors across different medical emergency patient populations? Results from the multi-national, prospective, observational TRIAGE study. Clin Chem Lab Med 2017;55:1873-80. DOI: https://doi.org/10.1515/cclm-2017-0144
Pieralli F, Vannucchi V, Mancini A, et al. procalcitonin kinetics in the first 72 hours predicts 30-day mortality in severely ill septic patients admitted to an Intermediate Care Unit. J Clin Med Res 2015;7:706-13. DOI: https://doi.org/10.14740/jocmr2251w
Becker K, Snider R, Nylen E. Procalcitonin assay in systemic inflammation, infection, and sepsis: Clinical utility and limitations. Crit Care Med 2008;36:941-52. DOI: https://doi.org/10.1097/CCM.0B013E318165BABB
de Jong E, van Oers JA, Beishuizen A, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis 2016;16:819-27. DOI: https://doi.org/10.1016/S1473-3099(16)00053-0
Adamik B, Kübler-Kielb J, Golebiowska B, et al. Effect of sepsis and cardiac surgery with cardiopulmonary bypass on plasma level of nitric oxide metabolites, neopterin, and procalcitonin: correlation with mortality and postoperative complications. Intensive Care Med 2000;26:1259-67. DOI: https://doi.org/10.1007/s001340000610
Meng FS, Su L, Tang YQ, et al. Serum procalcitonin at the time of admission to the ICU as a predictor of short-term mortality. Clin Biochem 2009;42:1025-31. DOI: https://doi.org/10.1016/j.clinbiochem.2009.03.012
Yin Q, Liu B, Chen Y, et al. The role of soluble thrombomodulin in the risk stratification and prognosis evaluation of septic patients in the emergency department. Thromb Res 2013;132:471-6. DOI: https://doi.org/10.1016/j.thromres.2013.08.011
Suberviola B, Castellanos-Ortega A, Ruiz Ruiz A, et al. Hospital mortality prognostication in sepsis using the new biomarkers suPAR and proADM in a single determination on ICU admission. Intensive Care Med 2013;39:1945-52. DOI: https://doi.org/10.1007/s00134-013-3056-z
Clec’h C, Fosse JP, Karoubi P, et al. Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock. Crit Care Med 2006;34:102-7. DOI: https://doi.org/10.1097/01.CCM.0000195012.54682.F3
Li Z, Wang H, Liu J, et al. Serum soluble triggering receptor expressed on myeloid cells-1 and procalcitonin can reflect sepsis severity and predict prognosis: a prospective cohort study. Mediators Inflamm 2014;2014:641039. DOI: https://doi.org/10.1155/2014/641039
Masson S, Caironi P, Spanuth E, et al. Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: data from the Albumin Italian Outcome Sepsis trial. Crit Care 2014;18:R6. DOI: https://doi.org/10.1186/cc13183
Yaroustovsky M, Plyushch M, Popov D, et al. Prognostic value of endotoxin activity assay in patients with severe sepsis after cardiac surgery. J Inflamm (Lond) 2014;10:8. DOI: https://doi.org/10.1186/1476-9255-10-8
Feng L, Zhou X, Su LX, et al. Clinical significance of soluble hemoglobin scavenger receptor CD163 (sCD163) in sepsis, a prospective study. PLoS One 2012;7:e38400. DOI: https://doi.org/10.1371/journal.pone.0038400
Jain S, Sinha S, Sharma SK, et al. Procalcitonin as a prognostic marker for sepsis: a prospective observational study. BMC Res Notes 2014;7:458. DOI: https://doi.org/10.1186/1756-0500-7-458
Dahaba AA, Hagara B, Fall A, et al. Procalcitonin for early prediction of survival outcome in postoperative critically ill patients with severe sepsis. Br J Anaesth 2006;97:503-8. DOI: https://doi.org/10.1093/bja/ael181
Magrini L, Travaglino F, Marino R, et al. Procalcitonin variations after Emergency Department admission are highly predictive of hospital mortality in patients with acute infectious diseases. Eur Rev Med Pharmacol Sci 2013;17:133-42.
Savva A, Raftogiannis M, Baziaka F, et al. Soluble urokinase plasminogen activator receptor (suPAR) for assessment of disease severity in ventilator-associated pneumonia and sepsis. J Infect 2011;63:344-50. DOI: https://doi.org/10.1016/j.jinf.2011.07.016
Kenzaka T, Okayama M, Kuroki S, et al. Use of a semiquantitative procalcitonin kit for evaluating severity and predicting mortality in patients with sepsis. Int J General Med 2012;5:483-8. DOI: https://doi.org/10.2147/IJGM.S32758
Giamarellos-Bourboulis EJ, Tsangaris I, Kanni T, et al. Procalcitonin as an early indicator of outcome in sepsis: a prospective observational study. J Hosp Infect 2011;77:58-63. DOI: https://doi.org/10.1016/j.jhin.2010.07.026
Liu D, Su L, Han G, et al. Prognostic value of procalcitonin in adult patients with sepsis: a systematic review and meta-analysis. PLoS One 2015;10:e0129450.
Tschaikowsky K, Hedwig-Geissing M, Braun GG, Radespiel-Troeger M. Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis. J Crit Care 2011;26:54-64. DOI: https://doi.org/10.1016/j.jcrc.2010.04.011
Schuetz P, Maurer P, Punjabi V, et al. Procalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patients. Crit Care 2013;17:R115. DOI: https://doi.org/10.1186/cc12787
Mat Nor MB, Md Ralib A. Procalcitonin clearance for early prediction of survival in critically ill patients with severe sepsis. Crit Care Res Pract 2014;2014:819034.
Ruiz-Rodríguez JC, Caballero J, Ruiz-Sanmartin A, et al. Usefulness of procalcitonin clearance as a prognostic biomarker in septic shock. A prospective pilot study. Med Intens 2014;36:475-80. DOI: https://doi.org/10.1016/j.medin.2011.11.024
Suberviola B, Castellanos-Ortega A, González-Castro A, et al. Prognostic value of procalcitonin, C-reactive protein and leukocytes in septic shock. Med Intens 2012;36:177-84. DOI: https://doi.org/10.1016/j.medin.2011.09.008
Karlsson S, Heikkinen M, Pettilä V, et al. Predictive value of procalcitonin decrease in patients with severe sepsis: A prospective observational study. Crit Care 2010;14:R205. DOI: https://doi.org/10.1186/cc9327
García de Guadiana-Romualdo LM, Rebollo-Acebes S, Esteban-Torrella P, et al. Prognostic value of lipopolysaccharide binding protein and procalcitonin in patients with severe sepsis and septic shock admitted to intensive care. Med Intens 2015;39:207-12. DOI: https://doi.org/10.1016/j.medin.2014.04.005
Guan J, Lin Z, Lue H. Dynamic change of procalcitonin, rather than concentration itself, is predictive of survival in septic shock patients when beyond 10 ng/mL. Shock 2011;36:570-4. DOI: https://doi.org/10.1097/SHK.0b013e31823533f9
Liu D, Su L, Han G, et al. Prognostic value of procalcitonin in adult patients with sepsis: a systematic review and meta-analysis. PLoS One 2015;10:e0129450. DOI: https://doi.org/10.1371/journal.pone.0129450
Liew YX, Chlebicki MP, Lee W, et al. Use of procalcitonin (PCT) to guide discontinuation of antibiotic use in an unspecified sepsis is an antimicrobial stewardship program (ASP). Eur J Clin Microbiol Infect Dis 2011;30:853-5. DOI: https://doi.org/10.1007/s10096-011-1165-6
Larson E. Community factors in the development of antibiotic resistance. Annu Rev Public Health 2007;28:435-47. DOI: https://doi.org/10.1146/annurev.publhealth.28.021406.144020
Scott F, James B, Ryan F, et al. Vital signs: improving antibiotic use among hospitalized patients. Mob Mort Wkly Rep 2014;63:194-200.
Lieberman JM. Appropriate antibiotic use and why it is important: the challenges of bacterial resistance. Pediatr Infect Dis J 2003;22:1143-51. DOI: https://doi.org/10.1097/01.inf.0000101851.57263.63
Simon P, Milbrandt EB, Emlet LL. PCT-guided antibiotics in severe sepsis. Crit Care 2008;12:309. DOI: https://doi.org/10.1186/cc7124
Chirouze C, Schuhmacher H, Rabaud C, et al. Low-serum procalcitonin level accuracy predicts the absence of bacteraemia in adult patients with acute fever. Clin Infect Dis 2002;35:156-61. DOI: https://doi.org/10.1086/341023
Schroeder S, Hochreiter M, Koehler T, et al. Procalcitonin (PCT )-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Langenbeck’s Arch Surg 2009;394:221-6. DOI: https://doi.org/10.1007/s00423-008-0432-1
Kip MM, Kusters R, Ijzerman J, Steuten MA. PCT algorithm for discontinuation of antibiotic therapy is a cost-effective way to reduce antibiotic exposure in adult intensive care patients with sepsis. J Med Econ 2015;18:944-53. DOI: https://doi.org/10.3111/13696998.2015.1064934
Lavrentieva A, Kontou P, Soulountsi V, et al. Implementation of a procalcitonin-guided algorithm for antibiotic therapy in the burn intensive care unit. Ann Burns Fire Disasters 2015;28:163-70.
Nobre V, Harbarth S, Graf JD, et al. Use of procalcitonin to shorten antibiotic treatment duration in septic patients. Am J Resp Crit Care Med 2008;177:498-505. DOI: https://doi.org/10.1164/rccm.200708-1238OC
Jensen J, Hein L, Lundgren B, et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: A randomized trial. Crit Care Med 2011;39:2048-58. DOI: https://doi.org/10.1097/CCM.0b013e31821e8791
Jensen J, Lundgren B, Hein L, et al. The Procalcitonin And Survival Study (PASS) - a randomised multi-center investigator- initiated trial to investigate whether daily measurements biomarker procalcitonin and pro-active diagnostic and therapeutic responses to abnormal Procalcitonin levels, can improve survival in intensive care unit patients. Calculated sample size (target population): 1000 patients. BMC Infect Dis 2008;8:91. DOI: https://doi.org/10.1186/1471-2334-8-91
Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 2013;13:426-35. DOI: https://doi.org/10.1016/S1473-3099(12)70323-7
Balk RA, Kadri SS, Cao Z, et al. Effect of procalcitonin testing on health-care utilization and costs in critically ill patients in the United States. Chest 2017;151:23-33. DOI: https://doi.org/10.1016/j.chest.2016.06.046
Liu F, Li L, Xu MD, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol 2020;127:104370. DOI: https://doi.org/10.1016/j.jcv.2020.104370
Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chim Acta 2020;505:190-1. Published online 2020 Mar 4. doi: 10.1016/j.cca.2020.03.004. DOI: https://doi.org/10.1016/j.cca.2020.03.004
Gharamti AA, Mei F, Jankousky KC, et al. Diagnostic utility of a ferritin-to-procalcitonin ratio to differentiate patients with COVID-19 from those with bacterial pneumonia: a multicenter study. Version 1. medRxiv. Preprint. 2020 Oct 22. doi: 10.1101/2020.10.20.20216309 DOI: https://doi.org/10.1101/2020.10.20.20216309
Meisner M, Rauschmayer C, Schmidt J, et al. Early increase of procalcitonin after cardiovascular surgery in patients with postoperative complications. Intensive Care Med 2002;28:1094-102. DOI: https://doi.org/10.1007/s00134-002-1392-5
Hensler T, Sauerland S, Lefering R, et al. The clinical value of procalcitonin and neopterin in predicting sepsis and organ failure after major trauma. Shock 2003;20:420-6. DOI: https://doi.org/10.1097/01.shk.0000093541.78705.38
Mokart D, Merlin M, Sannini A, et al. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): Early markers of postoperative sepsis after major surgery. Br J Anaesth 2005;94:767-73. DOI: https://doi.org/10.1093/bja/aei143
Reith H, Mittelko¨tter U, Debus E, et al. Procalcitonin in early detection of postoperative complications. Dig Surg 1998;15:260-5. DOI: https://doi.org/10.1159/000018625
Castelli G, Pognani C, Cita M, et al. Procalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: Diagnosis and monitoring of sepsis. Minerva Anestesiol 2006;72:69-80.
Novotny A, Emmanuel K, Hueser N, et al. Procalcitonin ratio indicates successful surgical treatment of abdominal sepsis. Surgery 2009;145:20-6. DOI: https://doi.org/10.1016/j.surg.2008.08.009

How to Cite

Cioni, G., Canini, J., & Pieralli, F. (2021). Procalcitonin in clinical practice: from diagnosis of sepsis to antibiotic therapy. Italian Journal of Medicine, 15(1). https://doi.org/10.4081/itjm.2021.1438

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