Impact of Procalcitonin Guidance on Management of Adults Hospitalized with Chronic Obstructive Pulmonary Disease Exacerbations

Abstract

Utilizing PCT guidance in the management of COPD exacerbations was associated with a decreased total duration of antibiotic therapy and hospital LOS without negatively impacting hospital readmissions.

Procalcitonin for Antibiotic Prescription in Chronic Obstructive Pulmonary Disease Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective

“…The existence of comorbidity was not comparable between exposed and non-exposed groups in one study [18]. We were unsure about the comparability between their exposed and non-exposed groups for two studies [13,25].…”

“…A total of 14 studies were included in the metaanalysis of PCT as a biomarker for COPD exacerbation ( Fig. 1) [6,[13][14][15][16][17][18][19][20][21][22][23][24][25]. Reasons for excluding studies are summarized in Supplementary Appendix 2; the most common reason for excluding a study was the lack of reported data specifically on COPD exacerbation.…”

“…Daubin et al and Stolz et al used lower PCT level cutoffs (0.1 and 0.1-0.25 lgÁL -1 , respectively) [6,20]. An important finding among these studies is that more than three-fourths of patients had PCT blood levels below the 0.25 lgÁL -1 threshold recommended by the FDA for antibiotic prescription [13,18,20]. There was a wide variance in mean PCT blood levels in COPD exacerbation ranging from 0.06 to 1.44 lgÁL -1 (Supplementary Appendix 3); some of this variation is related to higher PCT levels reported with pneumonia.…”

“…For observational studies, three studies used a before-after study design, and appropriate selection of a non-exposed group was unclear [13,18,25]. The existence of comorbidity was not comparable between exposed and non-exposed groups in one study [18].…”

Quality and safety in the literature: January 2020

“…For lower respiratory illnesses, these newer tests include rapid viral panels using PCR and the biomarker procalcitonin, the latter of which may be elevated in bacterial infections. The evidence is mixed for the benefit of procalcitonin to guide antimicrobial prescribing in acute exacerbations of COPD 12–15. C-reactive protein (CRP) is a biomarker that may be elevated in a variety of medical illnesses including infection.…”