(207) Value of Serum Procalcitonin in Guiding Anti-infective Therapy in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Meta-analysis and Systematic Review

Publication Number: 1199

Background: Chronic obstructive pulmonary disease (COPD) is a preventable chronic inflammatory disease of the airways. As the disease progresses, an acute onset, called acute exacerbation chronic obstructive pulmonary disease (AECOPD), may occur, which is the main cause of increased hospital admission or mortality. Serum procalcitonin (PCT) is more feasible to guide the use of antimicrobials. Several previous studies have suggested that PCT can guide antimicrobial use in patients with AECOPD, reducing antimicrobial prescribing rates and exacerbation rates, but PCT may be of poor diagnostic value for patients requiring admission to an Intensive Care Unit (ICU).

Objectives: To systematically evaluate the clinical value of PCT in the anti-infective treatment of AECOPD, reduce the prescription rate of antibacterial drugs and the exacerbation rate of infection, and provide evidence-based basis for the application of PCT indicators in the clinical treatment of patients with AECOPD.

Methods: Randomised controlled trials (RCTs) in databases up to April 2021 were searched. Citations retrieved from the database were sent to the EndnoteX7 software for literature management, relevant information was extracted, and included RCT studies were checked. Meta-analysis using STATA 12.0 to calculate the effect size relative risk (RR) of dichotomous variables using Mantel Haenszel's formula; The Inverse variance formula was used to calculate the Standard mean difference (SMD) of the effect size for the continuous variable.

Results: The initial search yielded 334 references and excluded 98 duplicates. Literature was screened according to exclusion criteria, and six studies with a total of 1096 patients were included for meta-analysis. Five studies reported the antimicrobial prescription rate of AECOPD patients treated in the PCT group versus the usual group, and collected data from a total of 888 patients, and their results showed that the antimicrobial prescription rate in the PCT group was 27% lower than that in the control group (RR = 0.73, 95% CI: 0.58~0.92, I2 = 65.3%). Two studies reported the duration of ICU admission to the ICU for AECOPD patients treated in the PCT versus conventional groups, and collected data from 510 patients, and their results showed that the PCT group had a shorter duration of intensive care unit (ICU) than the control group (SMD = 0.26, 95% CI: -0.43~-0.08, I2 = 0%).

Conclusions: PCT-guided AECOPD anti-infective therapy reduces antimicrobial prescription rates and shortens the duration of treatment for patients requiring ICU admission. Meta-analysis and systematic reviews of large, high-quality literature are still needed to provide a reliable basis for PCT-guided anti-infective treatment of AECOPD.