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首页> 外文期刊>Pulmonary therapy. >Procalcitonin for Antibiotic Prescription in Chronic Obstructive Pulmonary Disease Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective
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Procalcitonin for Antibiotic Prescription in Chronic Obstructive Pulmonary Disease Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective

机译：procalcitonin用于抗生素处方于慢性阻塞性肺病的恶化：系统评论，荟萃分析和临床观点

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The 2020 Global Initiative for Obstructive Lung Disease report indicates that the blood biomarker procalcitonin (PCT) may assist in decision-making regarding the initiation of antibiotics for chronic obstructive pulmonary disease (COPD) exacerbations. PCT is an acute-phase reactant that increases in response to inflammation and infection, and has been studied in various bacterial infections for initiation and de-escalation of antibacterials. The purpose of this systematic review and meta-analysis was to evaluate the strength of the data on the use of PCT to guide antibiotic prescription in COPD exacerbations. Among the randomized clinical trials included in our meta-analysis, almost all of which were conducted exclusively in the hospital setting. PCT was found to decrease overall antibiotic exposure in COPD exacerbations by 2.01?days ( p =?0.04), while no apparent effects were found on clinical outcomes (length of hospital stay, p =?0.88; treatment failure p =?0.51; all-cause mortality p =?0.28). However, the majority of blood PCT levels in COPD exacerbations were below the manufacturer-recommended cutoff for antibiotics, and the use of this marker was associated with worse outcomes in the intensive care setting. Further, based on additional sensitivity analysis excluding studies with high risk of bias?or with converted outcome value, the effect of PCT on antibiotic duration in RCTs was no longer significant (MD?=??1.88?days, 95% CI [?3.95, 0.19] days, p =?0.08, and MD?=??1.72?days, 95% CI [?4.28, 0.83] days, p =?0.19, respectively). Our review and analysis does not support the use of PCT to guide antibiotic prescription in COPD exacerbations.
机译：2020年阻塞性肺病报告的全球倡议表明，血液生物标志物ProCalcitonin（PCT）可以协助决策关于慢性阻塞性肺病（COPD）恶化的抗生素的启动。 PCT是一种急性相反应物，其响应于炎症和感染而增加，并且已经在各种细菌感染中进行了研究，用于引发和脱升升级抗菌。该系统审查和荟萃分析的目的是评估对PCT的数据的强度，以指导COPD加剧中的抗生素处方。在我们的荟萃分析中的随机临床试验中，几乎所有这些都是在医院环境中进行的。发现PCT将COPD加剧中的总体抗生素暴露减少2.01？天（P = 0.04），而在临床结果上没有发现明显的效果（住院住院的长度，P = 0.88;治疗失败P = 0.51;所有 - 死亡率p = 0.28）。然而，COPD加剧中的大多数血PCT水平低于制造商推荐的抗生素的截止，并且使用该标记的使用与重症监护环境中的更糟糕的结果有关。此外，基于额外的敏感性分析，不包括具有高偏差风险的研究？或随着转化的结果值，PCT对RCT中抗生素持续时间的影响不再有显着（MD？= ?? 1.88？天，95％CI [3.95 ，0.19]天，p = 0.08和MD？= ?? 1.72？天，95％CI [α4.28,0.83]天，P = 0.19分别）。我们的审查和分析不支持使用PCT来指导COPD恶化中的抗生素处方。

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