Procalcitonin: A promising tool or just another overhyped test?

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...

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Bibliographic Details
Published in:International journal of medical sciences 2020-01, Vol.17 (3), p.332-337
Main Authors: Paudel, Robin, Dogra, Prerna, Montgomery-Yates, Ashley A, Coz Yataco, Angel
Format: Article
Language:English
Subjects:
Animals
Anti-Bacterial Agents - therapeutic use
Antibiotics
Bacterial infections
Biomarkers
Biomarkers - metabolism
Bronchitis
Humans
Infections
Medical prognosis
Mortality
Physiology
Procalcitonin - metabolism
Respiratory Tract Infections - drug therapy
Respiratory Tract Infections - metabolism
Review
Sepsis
Sepsis - drug therapy
Sepsis - metabolism
Thyroid gland
Viral infections
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Summary: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.
ISSN:1449-1907
1449-1907
DOI:10.7150/ijms.39367