Benefits and Harms of Procalcitonin- or C-Reactive Protein-Guided Antimicrobial Discontinuation in Critically Ill Adults With Sepsis: A Systematic Review and Network Meta-Analysis*
Authors' conclusion
In sepsis, procalcitonin- or CRP-guided antibiotic discontinuation strategies may be beneficial and safe. In particular, the usefulness of procalcitonin guidance for current Sepsis-3, where antimicrobials are used for more than 7 days, was supported.
Study context
- Population
- Adults with sepsis in intensive care
- Participants
- 5,023 adults · 18 studies
- Comparison
- Procalcitonin- or C-reactive protein (CRP)-guided antibiotic discontinuation vs standard of care
- Outcome
- Duration of antibiotic treatment
Methodological detailsGRADE certainty assessment
- GRADE certainty assessment
Pooled result
As reported in the abstract
Each group vs standard of careDifference, days (95% CI)
Procalcitonin-guided
−1.89(−2.30 to −1.47)
CRP-guided
−2.56(−4.21 to −0.91)
Further pooled results
| Outcome | Difference (per 1000 participants) (95% CI) | |
|---|---|---|
| MortalityProcalcitonin-guided vs Standard of care · pronounced in Sepsis-3 | −27 (−45 to −7) | |
| −60−40−20020Difference, per 1000 participants (linear scale) |
Antibiotic duration, procalcitonin-guided subsets (subgroup)
- Benefit consistent with shorter baseline antimicrobial duration (7-10 d) or in Sepsis-3; more pronounced with cutoff "0.5 μg/L and 80% reduction"
- No benefit when monitoring frequency was less than half of the initial 10 days
Mortality
- CRP-guided strategies: no difference in mortality
Safety
Recurrence
- Did not increase significantly with either strategy
- Very low to low certainty
Original publication
Benefits and Harms of Procalcitonin- or C-Reactive Protein-Guided Antimicrobial Discontinuation in Critically Ill Adults With Sepsis: A Systematic Review and Network Meta-Analysis*. Crit Care Med. Published 1 July 2024. doi:10.
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