Antibiotska terapija vođena prokalcitoninom kod odraslih sepse: biohemijska perspektiva iz retrospektivne kohortne studije

Biochemical Evaluation of PCT-Guided Sepsis Treatment

  • Yi Zhang Prva pridružena bolnica Univerziteta Ksi'an Jiaotong
  • Zhe Liu Prva pridružena bolnica Univerziteta Ksi'an Jiaotong
  • Chen Ma Prva pridružena bolnica Univerziteta Ksi'an Jiaotong
  • Wenjing Wang Prva pridružena bolnica Univerziteta Ksi'an Jiaotong
  • Wei Chen Prva pridružena bolnica Univerziteta Ksi'an Jiaotong
DOI: https://doi.org/10.5937/jomb0-59980

Sažetak


Background: Procalcitonin (PCT), a biomarker closely associated with bacterial infections, has emerged as a valuable tool in guiding antibiotic therapy. In sepsis management, it may help optimize antibiotic use and improve clinical outcomes. This retrospective cohort study aimed to evaluate the effectiveness of PCT-guided antibiotic therapy in adult sepsis patients, with a particular focus on biochemical responses.

Methods: We retrospectively analyzed medical records of 110 adult sepsis patients admitted between January 2019 and December 2023. Patients were allocated to either a standard antibiotic group (n=53) or a PCT-guided antibiotic group (n=57). Key variables included demographic data, treatment duration, infection control metrics, and laboratory parameters such as white blood cell (WBC) count, C-reactive protein (CRP), and PCT levels before and after therapy.

Results: Compared to the standard group, the PCT-guided group exhibited significantly greater reductions in WBC, CRP, and PCT levels (P < 0.05), shorter antibiotic duration, fewer secondary infections, and improved antibiotic de-escalation rates. A higher complete response rate (17.54% vs. 3.77%) was also observed in the PCT-guided group. No significant difference was found in 28-day mortality.

Conclusions: PCT-guided antibiotic therapy led to more favorable changes in key biochemical markers and clinical outcomes, supporting its role as a biomarker-driven approach to antibiotic optimization in sepsis management.

Reference

Velissaris D, Zareifopoulos N, Lagadinou M, Platanaki C, Tsiotsios K, Stavridis EL, et al. Procalcitonin and sepsis in the Emergency Department: an update. Eur Rev Med Pharmacol Sci 2021; 25(1): 466-79.
2. López-Martínez MJ, Franco-Martínez L, Martínez-Subiela S, Cerón JJ. Biomarkers of sepsis in pigs, horses and cattle: from acute phase proteins to procalcitonin. Anim Health Res Rev 2022; 23(1): 82-99.
3. Wolf TA, Wimalawansa SJ, Razzaque MS. Procalcitonin as a biomarker for critically ill patients with sepsis: Effects of vitamin D supplementation. J Steroid Biochem Mol Biol 2019; 193: 105428.
4. Ho VP, Kaafarani H, Rattan R, Namias N, Evans H, Zakrison TL. Sepsis 2019: What Surgeons Need to Know. Surg Infect (Larchmt) 2020; 21(3): 195-204.
5. Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med 2016; 193(3): 259-72.
6. Mas-Celis F, Olea-López J, Parroquin-Maldonado JA. Sepsis in Trauma: A Deadly Complication. Arch Med Res 2021; 52(8): 808-16.
7. Papafilippou L, Claxton A, Dark P, Kostarelos K, Hadjidemetriou M. Nanotools for Sepsis Diagnosis and Treatment. Adv Healthc Mater 2021; 10(1): e2001378.
8. Velissaris D, Zareifopoulos N, Karamouzos V, Karanikolas E, Pierrakos C, Koniari I, et al. Presepsin as a Diagnostic and Prognostic Biomarker in Sepsis. Cureus 2021; 13(5): e15019.
9. Cantey JB, Lee JH. Biomarkers for the Diagnosis of Neonatal Sepsis. Clin Perinatol 2021; 48(2): 215-27.
10. Aloisio E, Dolci A, Panteghini M. Procalcitonin: Between evidence and critical issues. Clin Chim Acta 2019; 496: 7-12.
11. Paudel R, Dogra P, Montgomery-Yates AA, Coz Yataco A. Procalcitonin: A promising tool or just another overhyped test? Int J Med Sci 2020; 17(3): 332-7.
12. Ahuja N, Mishra A, Gupta R, Ray S. Biomarkers in sepsis-looking for the Holy Grail or chasing a mirage! World J Crit Care Med 2023; 12(4): 188-203.
13. Balkrishna A, Sinha S, Kumar A, Arya V, Gautam AK, Valis M, et al. Sepsis-mediated renal dysfunction: Pathophysiology, biomarkers and role of phytoconstituents in its management. Biomed Pharmacother 2023; 165: 115183.
14. Póvoa P, Coelho L, Dal-Pizzol F, Ferrer R, Huttner A, Conway Morris A, et al. How to use biomarkers of infection or sepsis at the bedside: guide to clinicians. Intensive Care Med 2023; 49(2): 142-53.
15. Zaki HA, Bensliman S, Bashir K, Iftikhar H, Fayed MH, Salem W, et al. Accuracy of procalcitonin for diagnosing sepsis in adult patients admitted to the emergency department: a systematic review and meta-analysis. Syst Rev 2024; 13(1): 37.
16. Maves RC, Enwezor CH. Uses of Procalcitonin as a Biomarker in Critical Care Medicine. Infect Dis Clin North Am 2022; 36(4): 897-909.
17. Reddy P. Clinical Approach to Nosocomial Bacterial Sepsis. Cureus 2022; 14(8): e28601.
18. Botondi V, D'Adamo E, Plebani M, Trubiani O, Perrotta M, Di Ricco L, et al. Perinatal presepsin assessment: a new sepsis diagnostic tool? Clin Chem Lab Med 2022; 60(8): 1136-44.
19. Chiarello MM, Fransvea P, Cariati M, Adams NJ, Bianchi V, Brisinda G. Anastomotic leakage in colorectal cancer surgery. Surg Oncol 2022; 40: 101708.
20. Kataria Y, Remick D. Sepsis Biomarkers. Methods Mol Biol 2021; 2321: 177-89.
21. Rose E. Pediatric Fever. Emerg Med Clin North Am 2021; 39(3): 627-39.
22. Chen Z, Turxun N, Ning F. Meta-analysis of the diagnostic value of procalcitonin in adult burn sepsis. Adv Clin Exp Med 2021; 30(4): 455-63.
23. Anugu NR, Khan S. Comparing the Diagnostic Accuracy of Procalcitonin and C-Reactive Protein in Neonatal Sepsis: A Systematic Review. Cureus 2021; 13(11): e19485.
24. Wojciechowski D, Wiseman A. Long-Term Immunosuppression Management: Opportunities and Uncertainties. Clin J Am Soc Nephrol 2021; 16(8): 1264-71.
25. Singh S, Amin AV, Loke YK. Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis. Arch Intern Med 2009; 169(3): 219-29.
26. Li X, Liu Z, Luo M, Xi Y, Li C, Wang S, et al. Therapeutic effect of low-molecular-weight heparin on adult sepsis: a meta-analysis. Ann Palliat Med 2021; 10(3): 3115-27.
27. Gregoriano C, Heilmann E, Molitor A, Schuetz P. Role of procalcitonin use in the management of sepsis. J Thorac Dis 2020; 12(Suppl 1): S5-s15.
28. Pierrakos C, Velissaris D, Bisdorff M, Marshall JC, Vincent JL. Biomarkers of sepsis: time for a reappraisal. Crit Care 2020; 24(1): 287.
29. Tosoni A, Paratore M, Piscitelli P, Addolorato G, De Cosmo S, Mirijello A. The use of procalcitonin for the management of sepsis in Internal Medicine wards: current evidence. Panminerva Med 2020; 62(1): 54-62.
30. Malik M, Sreekantan Nair A, Illango J, Siddiqui N, Gor R, Fernando RW, et al. The Advancement in Detecting Sepsis and Its Outcome: Usefulness of Procalcitonin in Diagnosing Sepsis and Predicting Fatal Outcomes in Patients Admitted to Intensive Care Unit. Cureus 2021; 13(4): e14439.
31. Niederman MS, Baron RM, Bouadma L, Calandra T, Daneman N, DeWaele J, et al. Initial antimicrobial management of sepsis. Crit Care 2021; 25(1): 307.
32. Hassan J, Khan S, Zahra R, Razaq A, Zain A, Razaq L, et al. Role of Procalcitonin and C-reactive Protein as Predictors of Sepsis and in Managing Sepsis in Postoperative Patients: A Systematic Review. Cureus 2022; 14(11): e31067.
33. Kim JH. Clinical Utility of Procalcitonin on Antibiotic Stewardship: A Narrative Review. Infect Chemother 2022; 54(4): 610-20.
34. Yadav P, Yadav SK. Progress in Diagnosis and Treatment of Neonatal Sepsis: A Review Article. JNMA J Nepal Med Assoc 2022; 60(247): 318-24.
Objavljeno
2025/10/01
Broj časopisa
Ahead of print
Rubrika
Original paper

Sva prava zadržana (c) 2025 Yi Zhang, Zhe Liu, Chen Ma, Wenjing Wang, Wei Chen

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