No significant reduction in antibiotic treatment using a procalcitonin algorithm with low cutoff value in the intensive care unit?

A randomized trial to compare procalcitonin and C-reactive protein in assessing severity of sepsis and in guiding antibacterial therapy in Egyptian critically ill patients

BACKGROUND

Procalcitonin (PCT) and C-reactive protein (CRP) are the main used biomarkers for sepsis and in guiding antibiotic therapy, although PCT high cost limits its use in developing countries.

OBJECTIVE

Comparing between PCT and CRP in assessing severity of sepsis and in guiding antibacterial therapy in critically ill patients.

METHODS

In a prospective randomized study, 60 patients were included from an Egyptian Intensive Care Unit. Patients were divided into CRP and PCT groups. CRP and PCT were measured at baseline and on days 4 and 7. Validity, sensitivity, and specificity of both biomarkers and their correlation with sepsis scores (Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sepsis-related Organ Failure Assessment (SOFA)) were evaluated. Antibacterial continuation at days 4 and 7 was assessed.

RESULTS

The diagnostic accuracy, specificity, and sensitivity of PCT were higher than CRP (80.79% vs 69.45%, 36% vs 28.7%, 87.6% vs 72.4%, respectively). PCT levels were significantly correlated with APACHE II score (P ≤ 0.0001) and SOFA score (P = 0.005), while CRP levels were not correlated with APACHEII and SOFA scores,(P > 0.05). PCT was associated with less antibacterial exposure (33% stopped their antibiotics on day 4 versus 6% in CRP, P = 0.009). Only 33% continued their antibacterial regimen in PCT group after 7 days versus 83% in CRP group (*P ≤ 0.0001).

CONCLUSION

PCT is a more accurate diagnostic and prognostic biomarker than CRP in patients with sepsis. PCT significantly shortened patients' exposure to antibacterial therapy and hospital length of stay.