Procalcitonin-Guided Stewardship Remains Effective in Patients with Impaired Kidney Function
This individual patient data meta-analysis of 15 RCTs (5,002 patients) addressed the concern that impaired renal clearance of procalcitonin might compromise its utility as an antibiotic stewardship tool. Even in CKD stage 5 patients, procalcitonin guidance reduced antibiotic duration by 2.5 days (11.3 vs. 8.6 days) without increasing mortality. Overall, PCT-guided care was associated with both shorter antibiotic courses and lower 30-day mortality (adjusted OR 0.88), confirming the biomarker's value across the full spectrum of kidney function.
The original study
Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: a patient-level meta-analysis from randomized controlled trials.
- Authors
- Heilmann E, Gregoriano C, Wirz Y, Luyt CE, Wolff M, Chastre J, et al.
- Journal
- Clinical chemistry and laboratory medicine
- Type
- Journal Article, Meta-Analysis
- PMID
- 32986609
Original abstract
OBJECTIVES: Patients with impaired kidney function have a significantly slower decrease of procalcitonin (PCT) levels during infection. Our aim was to study PCT-guided antibiotic stewardship and clinical outcomes in patients with impairments of kidney function as assessed by creatinine levels measured upon hospital admission. METHODS: We pooled and analyzed individual data from 15 randomized controlled trials who were randomly assigned to receive antibiotic therapy based on a PCT-algorithms or based on standard of care. We stratified patients on the initial glomerular filtration rate (GFR, ml/min/1.73 m2) in three groups (GFR >90 [chronic kidney disease; CKD 1], GFR 15-89 [CKD 2-4] and GFR<15 [CKD 5]). The main efficacy and safety endpoints were duration of antibiotic treatment and 30-day mortality. RESULTS: Mean duration of antibiotic treatment was significantly shorter in PCT-guided (n=2,492) compared to control patients (n=2,510) (9.5-7.6 days; adjusted difference in days -2.01 [95% CI, -2.45 to -1.58]). CKD 5 patients had overall longer treatment durations, but a 2.5-day reduction in treatment duration was still found in patients receiving in PCT-guided care (11.3 vs. 8.6 days [95% CI -3.59 to -1.40]). There were 397 deaths in 2,492 PCT-group patients (15.9%) compared to 460 deaths in 2,510 control patients (18.3%) (adjusted odds ratio, 0.88 [95% CI 0.78 to 0.98)]. Effects of PCT-guidance on antibiotic treatment duration and mortality were similar in subgroups stratified by infection type and clinical setting (p interaction >0.05). CONCLUSIONS: This individual patient data meta-analysis confirms that the use of PCT in patients with impaired kidney function, as assessed by admission creatinine levels, is associated with shorter antibiotic courses and lower mortality rates.