Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | http://hdl.handle.net/1843/42633 |
Resumo: | Background: The clinical utility of serum procalcitonin levels in guiding antibiotic treatment decisions in patients with sepsis remains unclear. This patient-level meta-analysis based on 11 randomized trials investigates the impact of procalcitonin-guided antibiotic therapy on mortality in intensive care unit (ICU) patients with infection, both overall and stratified according to sepsis definition, severity, and type of infection. Methods: For this meta-analysis focusing on procalcitonin-guided antibiotic management in critically ill patients with sepsis of any type, in February 2018 we updated the database of a previous individual patient data meta-analysis which was limited to patients with respiratory infections only. We used individual patient data from 11 trials that randomly assigned patients to receive antibiotics based on procalcitonin levels (the “procalcitonin-guided” group) or the current standard of care (the “controls”). The primary endpoint was mortality within 30 days. Secondary endpoints were duration of antibiotic treatment and length of stay. Results: Mortality in the 2252 procalcitonin-guided patients was significantly lower compared with the 2230 control group patients (21.1% vs 23.7%; adjusted odds ratio 0.89, 95% confidence interval (CI) 0.8 to 0.99; p = 0.03). These effects on mortality persisted in a subgroup of patients meeting the sepsis 3 definition and based on the severity of sepsis (assessed on the basis of the Sequential Organ Failure Assessment (SOFA) score, occurrence of septic shock or renal failure, and need for vasopressor or ventilatory support) and on the type of infection (respiratory, urinary tract, abdominal, skin, or central nervous system), with interaction for each analysis being > 0.05. Procalcitonin guidance also facilitated earlier discontinuation of antibiotics, with a reduction in treatment duration (9.3 vs 10.4 days; adjusted coefficient −1.19 days, 95% CI −1.73 to −0.66; p < 0.001).Conclusion: Procalcitonin-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and lower antibiotic treatment duration. |
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2022-06-23T21:52:21Z2022-06-23T21:52:21Z201822110.1186/s13054-018-2125-71364-8535http://hdl.handle.net/1843/42633Background: The clinical utility of serum procalcitonin levels in guiding antibiotic treatment decisions in patients with sepsis remains unclear. This patient-level meta-analysis based on 11 randomized trials investigates the impact of procalcitonin-guided antibiotic therapy on mortality in intensive care unit (ICU) patients with infection, both overall and stratified according to sepsis definition, severity, and type of infection. Methods: For this meta-analysis focusing on procalcitonin-guided antibiotic management in critically ill patients with sepsis of any type, in February 2018 we updated the database of a previous individual patient data meta-analysis which was limited to patients with respiratory infections only. We used individual patient data from 11 trials that randomly assigned patients to receive antibiotics based on procalcitonin levels (the “procalcitonin-guided” group) or the current standard of care (the “controls”). The primary endpoint was mortality within 30 days. Secondary endpoints were duration of antibiotic treatment and length of stay. Results: Mortality in the 2252 procalcitonin-guided patients was significantly lower compared with the 2230 control group patients (21.1% vs 23.7%; adjusted odds ratio 0.89, 95% confidence interval (CI) 0.8 to 0.99; p = 0.03). These effects on mortality persisted in a subgroup of patients meeting the sepsis 3 definition and based on the severity of sepsis (assessed on the basis of the Sequential Organ Failure Assessment (SOFA) score, occurrence of septic shock or renal failure, and need for vasopressor or ventilatory support) and on the type of infection (respiratory, urinary tract, abdominal, skin, or central nervous system), with interaction for each analysis being > 0.05. Procalcitonin guidance also facilitated earlier discontinuation of antibiotics, with a reduction in treatment duration (9.3 vs 10.4 days; adjusted coefficient −1.19 days, 95% CI −1.73 to −0.66; p < 0.001).Conclusion: Procalcitonin-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and lower antibiotic treatment duration.Introdução: A utilidade clínica dos níveis séricos de procalcitonina na orientação das decisões de tratamento com antibióticos em pacientes com sepse permanece obscura. Esta meta-análise em nível de paciente com base em 11 estudos randomizados investiga o impacto da antibioticoterapia guiada por procalcitonina na mortalidade em pacientes de unidade de terapia intensiva (UTI) com infecção, tanto geral e estratificada de acordo com a definição de sepse, gravidade e tipo de infecção. Métodos: Para esta meta-análise com foco no manejo antibiótico guiado por procalcitonina em pacientes críticos com sepse de qualquer tipo, em fevereiro de 2018 atualizamos o banco de dados de uma meta-análise de dados de pacientes individuais anteriores que foi limitado apenas a pacientes com infecções respiratórias. Usamos dados de pacientes individuais de 11 estudos que aleatoriamente pacientes designados para receber antibióticos com base nos níveis de procalcitonina (o grupo “guiado por procalcitonina”) ou o atual padrão de atendimento (os “controles”). O desfecho primário foi a mortalidade em 30 dias. Os endpoints secundários foram a duração de antibioticoterapia e tempo de internação. Resultados: A mortalidade nos 2.252 pacientes guiados por procalcitonina foi significativamente menor em comparação com os 2.230 pacientes do grupo controle (21,1% vs 23,7%; razão de chances ajustada 0,89, intervalo de confiança de 95% (IC) 0,8 a 0,99; p = 0,03). Esses efeitos sobre a mortalidade persistiram em um subgrupo de pacientes que atendem à definição de sepse 3 e com base na gravidade da sepse (avaliada com base no Sequential Organ Failure Assessment (SOFA) escore, ocorrência de choque séptico ou insuficiência renal e necessidade de vasopressor ou suporte ventilatório) e em o tipo de infecção (respiratória, urinária, abdominal, cutânea ou do sistema nervoso central), com interação para cada análise sendo > 0,05. A orientação de procalcitonina também facilitou a descontinuação precoce de antibióticos, com uma redução na duração do tratamento (9,3 vs 10,4 dias; coeficiente ajustado -1,19 dias, IC 95% -1,73 a -0,66; p < 0,001). Conclusão: O tratamento antibiótico guiado por procalcitonina em pacientes de UTI com infecção e sepse resulta em melhor sobrevida e menor duração do tratamento com antibióticos.engUniversidade Federal de Minas GeraisUFMGBrasilMED - DEPARTAMENTO DE CLÍNICA MÉDICACritical careSepseProcalcitoninaAdministração de antibióticosMeta-análiseEffect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trialsEfeito do tratamento antibiótico guiado por procalcitonina nos resultados clínicos em pacientes de unidade de terapia intensiva com infecção e sepse: uma meta-análise em nível de paciente de estudos randomizadosinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2125-7Yannick WirzDjillali AnnaneKonrad ReinhartPierre DamasMaarten NijstenArezoo ShajieiDylan W. DelangeRodrigo O. DeliberatoCarolina Ferreira de OliveiraYahya ShehabiJos Van OersMarc A. MeierAlbertus BeishuizenArmand R. J. GirbesEvelien de JongBeat MuellerPhilipp SchuetzLila BouadmaCharles LuytMichel WolffJean ChastreFlorence TubachStefan SchroederVandack Nobreapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/42633/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINAL2018_Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients- a patient-level meta-analysis of randomized trials.pdf2018_Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients- a patient-level meta-analysis of randomized trials.pdfapplication/pdf946653https://repositorio.ufmg.br/bitstream/1843/42633/2/2018_Effect%20of%20procalcitonin-guided%20antibiotic%20treatment%20on%20clinical%20outcomes%20in%20intensive%20care%20unit%20patients%20with%20infection%20and%20sepsis%20patients-%20a%20patient-level%20meta-analysis%20of%20randomized%20trials.pdf5029be6f6c5d0ed035ce7450290eba53MD521843/426332022-06-23 18:52:21.426oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2022-06-23T21:52:21Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials |
dc.title.alternative.pt_BR.fl_str_mv |
Efeito do tratamento antibiótico guiado por procalcitonina nos resultados clínicos em pacientes de unidade de terapia intensiva com infecção e sepse: uma meta-análise em nível de paciente de estudos randomizados |
title |
Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials |
spellingShingle |
Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials Yannick Wirz Sepse Procalcitonina Administração de antibióticos Meta-análise |
title_short |
Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials |
title_full |
Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials |
title_fullStr |
Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials |
title_full_unstemmed |
Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials |
title_sort |
Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials |
author |
Yannick Wirz |
author_facet |
Yannick Wirz Djillali Annane Konrad Reinhart Pierre Damas Maarten Nijsten Arezoo Shajiei Dylan W. Delange Rodrigo O. Deliberato Carolina Ferreira de Oliveira Yahya Shehabi Jos Van Oers Marc A. Meier Albertus Beishuizen Armand R. J. Girbes Evelien de Jong Beat Mueller Philipp Schuetz Lila Bouadma Charles Luyt Michel Wolff Jean Chastre Florence Tubach Stefan Schroeder Vandack Nobre |
author_role |
author |
author2 |
Djillali Annane Konrad Reinhart Pierre Damas Maarten Nijsten Arezoo Shajiei Dylan W. Delange Rodrigo O. Deliberato Carolina Ferreira de Oliveira Yahya Shehabi Jos Van Oers Marc A. Meier Albertus Beishuizen Armand R. J. Girbes Evelien de Jong Beat Mueller Philipp Schuetz Lila Bouadma Charles Luyt Michel Wolff Jean Chastre Florence Tubach Stefan Schroeder Vandack Nobre |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Yannick Wirz Djillali Annane Konrad Reinhart Pierre Damas Maarten Nijsten Arezoo Shajiei Dylan W. Delange Rodrigo O. Deliberato Carolina Ferreira de Oliveira Yahya Shehabi Jos Van Oers Marc A. Meier Albertus Beishuizen Armand R. J. Girbes Evelien de Jong Beat Mueller Philipp Schuetz Lila Bouadma Charles Luyt Michel Wolff Jean Chastre Florence Tubach Stefan Schroeder Vandack Nobre |
dc.subject.other.pt_BR.fl_str_mv |
Sepse Procalcitonina Administração de antibióticos Meta-análise |
topic |
Sepse Procalcitonina Administração de antibióticos Meta-análise |
description |
Background: The clinical utility of serum procalcitonin levels in guiding antibiotic treatment decisions in patients with sepsis remains unclear. This patient-level meta-analysis based on 11 randomized trials investigates the impact of procalcitonin-guided antibiotic therapy on mortality in intensive care unit (ICU) patients with infection, both overall and stratified according to sepsis definition, severity, and type of infection. Methods: For this meta-analysis focusing on procalcitonin-guided antibiotic management in critically ill patients with sepsis of any type, in February 2018 we updated the database of a previous individual patient data meta-analysis which was limited to patients with respiratory infections only. We used individual patient data from 11 trials that randomly assigned patients to receive antibiotics based on procalcitonin levels (the “procalcitonin-guided” group) or the current standard of care (the “controls”). The primary endpoint was mortality within 30 days. Secondary endpoints were duration of antibiotic treatment and length of stay. Results: Mortality in the 2252 procalcitonin-guided patients was significantly lower compared with the 2230 control group patients (21.1% vs 23.7%; adjusted odds ratio 0.89, 95% confidence interval (CI) 0.8 to 0.99; p = 0.03). These effects on mortality persisted in a subgroup of patients meeting the sepsis 3 definition and based on the severity of sepsis (assessed on the basis of the Sequential Organ Failure Assessment (SOFA) score, occurrence of septic shock or renal failure, and need for vasopressor or ventilatory support) and on the type of infection (respiratory, urinary tract, abdominal, skin, or central nervous system), with interaction for each analysis being > 0.05. Procalcitonin guidance also facilitated earlier discontinuation of antibiotics, with a reduction in treatment duration (9.3 vs 10.4 days; adjusted coefficient −1.19 days, 95% CI −1.73 to −0.66; p < 0.001).Conclusion: Procalcitonin-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and lower antibiotic treatment duration. |
publishDate |
2018 |
dc.date.issued.fl_str_mv |
2018 |
dc.date.accessioned.fl_str_mv |
2022-06-23T21:52:21Z |
dc.date.available.fl_str_mv |
2022-06-23T21:52:21Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/42633 |
dc.identifier.doi.pt_BR.fl_str_mv |
10.1186/s13054-018-2125-7 |
dc.identifier.issn.pt_BR.fl_str_mv |
1364-8535 |
identifier_str_mv |
10.1186/s13054-018-2125-7 1364-8535 |
url |
http://hdl.handle.net/1843/42633 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.pt_BR.fl_str_mv |
Critical care |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
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Universidade Federal de Minas Gerais |
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UFMG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
MED - DEPARTAMENTO DE CLÍNICA MÉDICA |
publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
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