CHEST Guidelines-Additional-Real-World-Evidence-Supporting-Procalci

Additional-Real-World-Evidence-Supporting-Procalci

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The editorial by Philipp Schuetz and Peter M. Wahl argues for the use of procalcitonin (PCT) as a crucial biomarker to guide antibiotic management in critically ill patients, especially those with sepsis. Traditional diagnostics for systemic infections rely on sensitivity and specificity but face challenges due to low blood culture sensitivity. The authors highlight randomized controlled trials that show PCT can significantly reduce antibiotic use by 30% to 70%, depending on the setting. Moreover, recent trials indicate a survival benefit in critical care with PCT usage.<br /><br />Despite substantial findings from randomized trials, real-world evidence is essential to understand how PCT protocols perform outside controlled environments. A study by Balk and colleagues explored over 33,000 critically ill patients using PCT and about 100,000 without it, from the Premier Healthcare Database. Utilizing propensity score matching, they addressed confounding factors by comparing patient demographics, hospital, and clinical characteristics, indicating robust internal study validity.<br /><br />Although there may be limitations due to potential biases in observational data, the study found significant results: PCT-guided treatments led to reduced antibiotic exposure, shorter hospital stays, and lower healthcare costs by approximately 10%, even though it did not reduce mortality. These findings support broader adoption of PCT protocols globally, especially since most research data are from Europe and Asia, and data from US-based studies remain scarce.<br /><br />Current guidelines from the Surviving Sepsis Campaign provide a cautious recommendation (grade 2C) for PCT use. However, the editors argue that the substantial evidence from trials and real-world data should prompt clinicians to embrace PCT protocols more widely, offering a potential turning point in the treatment guidelines and practices for sepsis and other critical conditions.

Keywords

procalcitonin

biomarker

antibiotic management

sepsis

randomized controlled trials

real-world evidence

propensity score matching

healthcare costs

Surviving Sepsis Campaign

treatment guidelines