Ineffectiveness of Procalcitonin-guided Antibiotic Therapy in Severely Critically Ill Patients: A Meta-Analysis

Abstract Background Optimizing antibiotics therapy holds an important impact on the management of critically ill patients. Procalcitonin (PCT) is regarded to be of possible in the guidance of the antibiotics stewardship, however, its efficacy remains controversial. Thus, we performed a meta-analysis in the efficacy of PCT-guided antibiotics therapy in critically ill patients. Methods Relevant literature was searched in PubMed, Embase, Web of Science, and the Cochrane Library from 2004 to Aug 2018. Randomized controlled trials (RCTs) were included if critically ill patients were treated with a PCT-guided antibiotics therapy or standard care. The primary outcome was short-term mortality, secondary endpoints were the duration of antibiotic treatment, ICU length of stay (LOS), and hospital LOS. Results Sixteen RCTs enrolling 6452 critically ill patients were included in this analysis. Pooled analysis demonstrated a comparable short-term mortality (RR 0.90; 95% CI 0.80 – 1.01; p  =  0.07), ICU LOS (MD 0.38; 95% CI -0.05 – 0.81; p = 0.09), hospital LOS (MD 0.19; 95% CI -1.56 – 1.95; p  =  0.83), and 0.99 (95% CI -1.85 – -0.13; p  =  0.02) days shorter antibiotic duration between PCT-guided antibiotics therapy with standard antibiotics therapy. Patients with average SOFA p  =  0.04) compared with standard care group, while no difference was found in subgroup of SOFA > 8 (RR 0.85; 95% CI 0.66 – 1.11; p  =  0.23). Conclusion PCT-guided antibiotic therapy fails to decrease the mortality or LOS of the critically ill patients with suspected or confirmed sepsis. PCT-guided cessation of antibiotic therapy could reduce the mortality in patients with average SOFA   8.