Original Title: Utilidad clínica de la procalcitonina como herramienta para guiar el inicio de terapia antimicrobiana en pacientes ingresados en UCI. Revisión Sistemática

Authors' objectives: The aim of this report was to assess the safety and clinical efficacy of using the determination of PCT in critical adult patients or with SIRS admitted to the ICU as a marker for the initiation of antimicrobial therapy for the reduction of in-hospital mortality.

Authors' results and conclusions: RESULTS A total of 281 references were identified, but only 3 met the eligibility criteria and were included in the review. The main results by outcome have been: • Mortality: in all studies the use of serum PCT levels for the initiation of antibiotic treatment did not affect in-hospital mortality; the meta-analysis performed did not show significant differences between the PCT group and the control group with a RR of 1.02 (95% CI 0.75, 1.39). The sequential analysis of trials (TSA) has indicated that despite not reaching the necessary sample size the information available with these studies would be sufficient to indicate that there are no differences between the two interventions. • Exposure to antibiotics: in two studies the use of serum levels of PCT for the initiation of antibiotic treatment supposes a significant reduction of the antibiotic exposure, on the contrary in the third study no such reduction was found, although in this last study there was lack of adherence to the protocol established for the indication of antibiotic treatment. • Hospital or ICU stay: in all studies the use of serum PCT levels for the initiation of antibiotic treatment does not mean a significant reduction in hospital stay.It is not clear whether it could reduce ICU stay because of contradictory data among the studies. CONCLUSIONS Useof PCT in clinical algorithms for the initiation of antibiotic therapy in patients admitted to the ICU does not modify mortality (Grade: moderate evidence quality).

Authors' recommendations: Evidence from studies with lower risk of bias suggests that the use of PCT levels as an algorithm for the initiation of antibiotic treatment could reduce antibiotic exposure in patients admitted to the ICU.

Authors' methods: A systematic review of the literature was performed. A bibliographic searchin the main international databasesto compile the scientific evidence published until June 2018was carried out. A critical appraisal of selected studies was performedto identify the methodological problems that could influence their validity,as well as an assessment of the quality using the GRADE criteria. Finally, a qualitative and quantitative synthesis (when it was possible) of the results has been made.

Project Status: Completed

Year Published: 2019

URL for published report: https://www.aetsa.org/publicacion/utilidad-cinica-de-la-procalcitonina-como-herramienta-para-guiar-el-inicio-de-terapia-antimicrobiana-en-pacientes-ingresados-en-uci-revision-sistematica/

Requestor: Health Ministry of Spain

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: Andalusian Agency for Health Technology Assessment (AETSA)