Table 2.
Overview of trials examining PCT-guided therapy in COPD patients.
| First Author, Year | n with COPD | Population | Intervention Design | Results among COPD Patients with PCT-Guided Therapy |
|---|---|---|---|---|
| Christ-Crain, 2004 [82] | 60/243 | Emergency department patients with suspected lower respiratory tract infections. | Open-label. PCT measured at admission and after 6–24 h. PCT cut-offs at 0.1, 0.25, and 0.5 μg/L. * | A 56% reduction in antibiotics prescription. No difference in risk of death, readmission, or future exacerbations. |
| Corti, 2016 [83] | 120 | Patients admitted with AECOPD. | Open-label. PCT measured sequentially at admission and on days 3, 5, and 7. PCT cut-offs at 0.1, 0.25, and 0.5 μg/L. * | Antibiotic exposure reduced from 8.5 days (IQR 1–11) to 3.5 days (IQR 1–10). No difference in composite endpoint of death, rehospitalization and ICU admission within 28 days. |
| Daubin, 2018 [86] | 302 | COPD patients admitted to ICU with AECOPD | Open-label. PCT measured sequentially at admission and on days 3 and 5. PCT cut-offs at 0.1, 0.25, and 0.5 μg/L. * | PCT-guided therapy increased mortality from 12% in the control group to 31% in the PCT-guided group. |
| Huang, 2018 [81] | 524/1656 | Emergency department patients with suspected lower respiratory tract infections. | Open-label. PCT measured sequentially at admission and on days 3, 5, 7. PCT cut-offs at 0.1, 0.25, and 0.5 μg/L. * | No difference in antibiotic prescriptions. No differences in composite outcome of death, ICU admission and readmission. |
| Kristoffersen, 2009 [88] | 89/120 | Patients admitted with suspected lower respiratory tract infections. | Open-label. PCT measured at admission. PCT cut-off at 0.25 μg/L. ** | Antibiotic exposure reduced from 6.8 (95% CI 5.9–7.7) days to 5.1 (4.4–6.0) days among all patients included. No difference in ICU admission or death. |
| Schuetz, 2009 [80] | 533/1359 | Emergency department patients with suspected lower respiratory tract infections. | Open-label. PCT measured at admission, discharge and on days 3, 5 and 7. PCT cut-offs at 0.1, 0.25, and 0.5 μg/L. * | Antibiotic prescription rates reduced from 69.9% to 48.7%. No difference in composite outcome of death, ICU admission, reinfection, abscess formation, and empyema within 30 days. |
| Stoltz, 2007 [84] | 226 | Patients admitted with AECOPD. | Open label. PCT measured at admission. Antibiotics discouraged at PCT of <0.1 μg/L and encouraged at PCT of >0.25 μg/L. | Antibiotic prescription rate reduced from 72% to 40%. No difference in composite of self-reported symptoms and death. |
| Verduri, 2015 [85] | 183 | Patients admitted with AECOPD. | Open-label. PCT measured on days 1,2 and 3. Antibiotics stopped on day 3 if all measurements were <0.1 μg/L, or if all measurements were <0.25 and the patient was clinically stable. | In total, 45 of 88 patients in the PCT-guided group received treatment for 3 days rather than 10. No difference in re-exacerbation rate. |
| Wang, 2016 [87] | 194 | Patients admitted with AECOPD and PCT of <0.1 μg/L. | Open-label. PCT of <0.1 was a criterium for inclusion. Randomized to either antibiotics or no antibiotics. | No differences in self-reported symptoms, length of stay, ICU admission, mortality or rehospitalization. |
* Antibiotics strongly discouraged at PCT < 0.1, discouraged at PCT < 0.25, encouraged at PCT > 0.25, and strongly encouraged at PCT > 0.5. ** Antibiotics discouraged at PCT < 0.25, and encouraged at PCT > 0.25.