Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock

Detalhes bibliográficos
Autor(a) principal: Silva, Brenda Nazaré Gomes da [UNIFESP]
Data de Publicação: 2017
Outros Autores: Andriolo, Regis Bruni [UNIFESP], Salomão, Reinaldo [UNIFESP], Atallah, Álvaro Nagib [UNIFESP]
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://dx.doi.org/10.1002/14651858.CD010959.pub2
https://repositorio.unifesp.br/handle/11600/56413
Resumo: Background Serum procalcitonin (PCT) evaluation has been proposed for early diagnosis and accurate staging and to guide decisions regarding patients with sepsis, severe sepsis and septic shock, with possible reduction in mortality. Objectives To assess the effectiveness and safety of serum PCT evaluation for reducing mortality and duration of antimicrobial therapy in adults with sepsis, severe sepsis or septic shock. Search methods We searched the Central Register of Controlled Trials (CENTRAL
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spelling Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shockBackground Serum procalcitonin (PCT) evaluation has been proposed for early diagnosis and accurate staging and to guide decisions regarding patients with sepsis, severe sepsis and septic shock, with possible reduction in mortality. Objectives To assess the effectiveness and safety of serum PCT evaluation for reducing mortality and duration of antimicrobial therapy in adults with sepsis, severe sepsis or septic shock. Search methods We searched the Central Register of Controlled Trials (CENTRAL2015, Issue 7)MEDLINE (1950 to July 2015)Embase (Ovid SP, 1980 to July 2015)Latin American Caribbean Health Sciences Literature (LILACS via BIREME, 1982 to July 2015)and the Cumulative Index to Nursing and Allied Health Literature (CINAHLEBSCO host, 1982 to July 2015), and trial registers (ISRCTN registry, ClinicalTrials.gov and CenterWatch, to July 2015). We reran the search in October 2016. We added three studies of interest to a list of 'Studies awaiting classification' and will incorporate these into formal review findings during the review update. Selection criteria We included only randomized controlled trials (RCTs) testing PCT-guided decisions in at least one of the comparison arms for adults (>= 18 years old) with sepsis, severe sepsis or septic shock, according to international definitions and irrespective of the setting. Data collection and analysis Two review authors extracted study data and assessed the methodological quality of included studies. We conducted meta-analysis with random-effects models for the following primary outcomes: mortality and time spent receiving antimicrobial therapy in hospital and in the intensive care unit (ICU), as well as time spent on mechanical ventilation and change in antimicrobial regimen from a broad to a narrower spectrum. Main results We included 10 trials with 1215 participants. Low-quality evidence showed no significant differences in mortality at longest follow-up (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.65 to 1.01I-2 = 10%10 trialsN = 1156), at 28 days (RR 0.89, 95% CI 0.61 to 1.31I-2 = 0%four trialsN = 316), at ICU discharge (RR 1.03, 95% CI 0.50 to 2.11I-2 = 49%three trialsN = 506) and at hospital discharge (RR 0.98, 95% CI 0.75 to 1.27I-2 = 0%seven trialsN = 805moderate-quality evidence). However, mean time receiving antimicrobial therapy in the intervention groups was -1.28 days (95% CI to -1.95 to -0.61I-2 = 86%four trialsN = 313very low-quality evidence). No primary study has analysed the change in antimicrobial regimen from a broad to a narrower spectrum. Authors' conclusions Up-to-date evidence of very low to moderate quality, with insufficient sample power per outcome, does not clearly support the use of procalcitonin-guided antimicrobial therapy to minimize mortality, mechanical ventilation, clinical severity, reinfection or duration of antimicrobial therapy of patients with septic conditions.Cochrane Brazil, Ctr Estudos Saude Baseada Evidencias Avaliacao Te, Sao Paulo, BrazilUniv Estado Para, Dept Publ Hlth, Travessa Perebebui 2623, BR-66087670 Belem, Para, BrazilUniv Fed Sao Paulo, Dept Med, Sao Paulo, BrazilCochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, BrazilDepartment of Medicine, Universidade Federal de São Paulo, São Paulo, BrazilWeb of ScienceCochrane Anaesthesia, Critical and Emergency Care Group (ACE)Wiley2020-07-31T12:46:51Z2020-07-31T12:46:51Z2017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion-application/pdfhttp://dx.doi.org/10.1002/14651858.CD010959.pub2Cochrane Database Of Systematic Reviews. Hoboken, v. , n. 1, p. -, 2017.10.1002/14651858.CD010959.pub2WOS000396096100015.pdf1469-493Xhttps://repositorio.unifesp.br/handle/11600/56413WOS:000396096100015engCochrane Database Of Systematic ReviewsHobokeninfo:eu-repo/semantics/openAccessSilva, Brenda Nazaré Gomes da [UNIFESP]Andriolo, Regis Bruni [UNIFESP]Salomão, Reinaldo [UNIFESP]Atallah, Álvaro Nagib [UNIFESP]reponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-03T09:57:46Zoai:repositorio.unifesp.br/:11600/56413Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-08-03T09:57:46Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock
title Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock
spellingShingle Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock
Silva, Brenda Nazaré Gomes da [UNIFESP]
title_short Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock
title_full Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock
title_fullStr Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock
title_full_unstemmed Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock
title_sort Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock
author Silva, Brenda Nazaré Gomes da [UNIFESP]
author_facet Silva, Brenda Nazaré Gomes da [UNIFESP]
Andriolo, Regis Bruni [UNIFESP]
Salomão, Reinaldo [UNIFESP]
Atallah, Álvaro Nagib [UNIFESP]
author_role author
author2 Andriolo, Regis Bruni [UNIFESP]
Salomão, Reinaldo [UNIFESP]
Atallah, Álvaro Nagib [UNIFESP]
author2_role author
author
author
dc.contributor.author.fl_str_mv Silva, Brenda Nazaré Gomes da [UNIFESP]
Andriolo, Regis Bruni [UNIFESP]
Salomão, Reinaldo [UNIFESP]
Atallah, Álvaro Nagib [UNIFESP]
description Background Serum procalcitonin (PCT) evaluation has been proposed for early diagnosis and accurate staging and to guide decisions regarding patients with sepsis, severe sepsis and septic shock, with possible reduction in mortality. Objectives To assess the effectiveness and safety of serum PCT evaluation for reducing mortality and duration of antimicrobial therapy in adults with sepsis, severe sepsis or septic shock. Search methods We searched the Central Register of Controlled Trials (CENTRAL
publishDate 2017
dc.date.none.fl_str_mv 2017
2020-07-31T12:46:51Z
2020-07-31T12:46:51Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1002/14651858.CD010959.pub2
Cochrane Database Of Systematic Reviews. Hoboken, v. , n. 1, p. -, 2017.
10.1002/14651858.CD010959.pub2
WOS000396096100015.pdf
1469-493X
https://repositorio.unifesp.br/handle/11600/56413
WOS:000396096100015
url http://dx.doi.org/10.1002/14651858.CD010959.pub2
https://repositorio.unifesp.br/handle/11600/56413
identifier_str_mv Cochrane Database Of Systematic Reviews. Hoboken, v. , n. 1, p. -, 2017.
10.1002/14651858.CD010959.pub2
WOS000396096100015.pdf
1469-493X
WOS:000396096100015
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Cochrane Database Of Systematic Reviews
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv -
application/pdf
dc.coverage.none.fl_str_mv Hoboken
dc.publisher.none.fl_str_mv Wiley
publisher.none.fl_str_mv Wiley
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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