Potential of serum procalcitonin in predicting bacterial exacerbation and guiding antibiotic administration in severe COPD exacerbations: a systematic review and meta-analysis

Abstract

Background: The value of procalcitonin (PCT) in the diagnosis of bacterial infections and for determining antibiotic usage among patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is currently unclear.

Methods: We systematically reviewed the literature and selected studies that evaluated PCT as a biomarker for predicting bacterial infection and compared PCT-based protocols to determine its application in the initiation or discontinuation of antibiotics. Guidance for systematic reviews from Cochrane and the GRADE were followed to perform this study. Data were pooled and analyzed by using a random-effects or a fixed-effects model based on the heterogeneity.

Results: The pooled sensitivity and specificity of PCT in diagnosing respiratory bacterial infections were 0.60 and 0.76, respectively, with the area under the summary receiver operating characteristic curve of 0.77. Subgroup analysis showed that the sensitivity and specificity of PCT for patients in ICU were 0.48 and 0.69, respectively. PCT-based protocols decreased antibiotic prescription (relative risk = 0.66, 95% CI: 0.62–0.71) and total antibiotic exposure (mean difference = −2.60, 95% CI: −4.48–0.72), without affecting clinical outcomes such as treatment failure, length of hospitalization and rates of re-exacerbation or overall mortality.

Conclusions: PCT has a moderate ability to distinguish bacterial respiratory infection in patients with AECOPD. PCT-guided algorithm can reduce unnecessary administration of antibiotics without increasing adverse outcomes. However, for patients requiring admission in the ICU, PCT may have a poor diagnostic value, and the PCT-guided algorithm may not effectively and safely reduce the antibiotic exposure.

Keywords:

• COPD;
• acute exacerbation;
• bacterial infection;
• procalcitonin;
• antibiotics;
• systematic review

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The work was supported by grants Peking University People’s Hospital Research and Development Funds (RDY2018-14) and Ministry of Science and Technology of China (2017ZX10103004-006). The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.