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

被引:71
作者
Cabral, Luis [1 ,2 ,3 ]
Afreixo, Vera [4 ,5 ]
Almeida, Luis [6 ]
Paiva, Jose Artur [6 ,7 ]
机构
[1] CHUC, Dept Plast Surg, Coimbra, Portugal
[2] CHUC, Burns Unit, Coimbra, Portugal
[3] Univ Aveiro, SACS, Autonomous Sect Hlth Sci, Aveiro, Portugal
[4] Univ Aveiro, Ctr Res & Dev Math & Applicat, CIDMA, Aveiro, Portugal
[5] Univ Aveiro, Inst Biomed, iBiMED, Aveiro, Portugal
[6] Univ Porto, Fac Med, Dept Pharmacol & Therapeut, Oporto, Portugal
[7] Ctr Hosp Sao Joao, Dept Emergency & Intens Care Med, Oporto, Portugal
关键词
ANTIBIOTIC-THERAPY; SERUM PROCALCITONIN; ANTIMICROBIAL THERAPY; GUIDED ALGORITHMS; INFECTIONS; BACTEREMIA; INITIATION; INDICATOR; MARKERS; INJURY;
D O I
10.1371/journal.pone.0168475
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
070301 [无机化学]; 070403 [天体物理学]; 070507 [自然资源与国土空间规划学]; 090105 [作物生产系统与生态工程];
摘要
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% Cl = 0.76 to 0.90); the estimated cut-off is 1.47 ng/m L. The overall sepsis effect in PCT levels is significant and strong (Cohen's d is 2.1 and 95% Cl = 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.
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页数:16
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