The Use of Procalcitonin (PCT) for Diagnosis of Sepsis in Burn Patients: A Meta-Analysis

• Published in: PloS one Vol. 11; no. 12; p. e0168475
• Main Authors: Cabral, Luís, Afreixo, Vera, Almeida, Luís, Paiva, José Artur
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22.12.2016; Public Library of Science (PLoS)
• Subjects: Algorithms; Anti-infective agents; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; Bacterial infections; Bioindicators; Biology and Life Sciences; Biomarkers; Biomarkers - blood; Blood levels; Burn patients; Burns; Burns - complications; Calcitonin - blood; Care and treatment; Case-Control Studies; Catheters; Diagnostic systems; Disseminated infection; Dosage and administration; Health care; Humans; Infection; Infections; Intensive care; Laboratory tests; Medical diagnosis; Medical ethics; Medicine; Medicine and Health Sciences; Meta-analysis; Microorganisms; Mortality; Patients; Physical Sciences; Procalcitonin; Prognosis; Protein Precursors - blood; Research and Analysis Methods; Resuscitation; Risk factors; Sepsis; Sepsis - blood; Sepsis - diagnosis; Sepsis - etiology; Studies; Systematic review; Therapy; Portugal
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0168475

The continuous development of resuscitation techniques and intensive care reduced the mortality rate induced by the initial shock in burn patients and, currently, infections (especially sepsis) are the main causes of mortality of these patients. The misuse of antimicrobial agents is strongly related to antimicrobial and adverse patient outcomes, development of microbial resistance and increased healthcare-related costs. To overcome these risks, antimicrobial stewardship is mandatory and biomarkers are useful to avoid unnecessary medical prescription, to monitor antimicrobial therapy and to support the decision of its stop. Among a large array of laboratory tests, procalcitonin (PCT) emerged as the leading biomarker to accurately and time-effectively indicate the presence of systemic infection. In the presence of systemic infection, PCT blood levels undergo a sudden and dramatic increase, following the course of the infection, and quickly subside after the control of the septic process. This work is a meta-analysis on PCT performance as a biomarker for sepsis. This meta-analysis showed that overall pooled area under the curve (AUC) is 0.83 (95% CI = 0.76 to 0.90); the estimated cut-off is 1.47 ng/mL. The overall sepsis effect in PCT levels is significant and strong (Cohen's d is 2.1 and 95% CI = 1.1 to 3.2). This meta-analysis showed PCT may be considered as a biomarker with a strong diagnostic ability to discriminate between the septic from the non-septic burn patients. Thus, this work encourages the determination of PCT levels in clinical practice for the management of these patients, in order to timely identify the susceptibility to sepsis and to initiate the antimicrobial therapy, improving the patients' outcomes.