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2026, Number 1

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Med Crit 2026; 40 (1)

Association of procalcitonin monitoring with clinical outcomes in critically ill patients: retrospective cohort

Sevilla VAY, Zaragoza JJ, Cambrón PJP, Ramírez BDK, Portillo PM, Rodríguez GJH

Language: Spanish
References: 15
Page: 8-13
PDF size: 371.61 Kb.


ABSTRACT

Introduction: we evaluated the association between intensive procalcitonin monitoring and clinical outcomes in the ICU. In this retrospective cohort, the monitoring strategy used did not reduce antibiotic duration and was associated with longer stay and mechanical ventilation, without impact on mortality. These findings suggest differences between clinical practice and controlled trials. Objective: to evaluate the association between an intensive procalcitonin monitoring strategy and the duration of antibiotic therapy, as well as other clinical outcomes in the ICU. Material and methods: retrospective cohort study including adults admitted to the ICU with suspected infection between January 2024 and May 2025. Patients were grouped into Intensive Monitoring (≥ 2 procalcitonin measurements) and limited monitoring (0-1). The primary outcome was the duration of first-line antibiotics; secondary outcomes included ICU length of stay, days on mechanical ventilation, hospital mortality, and multidrug-resistant infections. Results: a total of 526 patients were analyzed: 387 in limited monitoring and 139 in intensive monitoring. The intensive group had higher severity at admission (SAPS 3: 25.7 versus 8.0; p ‹ 0.001) and more sepsis (47.5 versus 9.6%; p ‹ 0.001). Intensive monitoring was associated with a lower probability of antibiotic discontinuation (hazard ratio [HR] 0.53), ICU discharge (HR 0.35), and mechanical ventilation liberation (HR 0.26). No significant differences were found in mortality or multidrug-resistant infections. Conclusions: intensive procalcitonin monitoring was paradoxically linked to longer antibiotic therapy and supportive measures, reflecting the greater clinical complexity of patients undergoing intensive monitoring.


REFERENCES

  1. Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin toreduce patients’ exposure to antibiotics in intensive care units(PRORATA trial): a multicentre randomised controlled trial.Lancet. 2010;375(9713):463-474. Available in: https://doi.org/10.1016/S0140-6736(09)61879-1

  2. Huang DT, Yealy DM, Angus DC. Longer-term outcomes of theProACT trial. N Engl J Med. 2020;382:485-486. Available in:https://doi.org/10.1056/NEJMc1910508

  3. Huang DT, Yealy DM, Filbin MR, et al. Procalcitonin-guideduse of antibiotics for lower respiratory tract infection. N Engl JMed. 2018;379(3):236-249. Available in: https://doi.org/10.1056/NEJMoa1802670

  4. Dark P, Hossain A, McAuley DF, et al. Biomarker-guidedantibiotic duration for hospitalized patients with suspectedsepsis: the ADAPT-sepsis randomized clinical trial. JAMA.2025;333(8):682-693. Available in: https://doi.org/10.1001/jama.2024.26458

  5. Schuetz P, Wirz Y, Sager R, et al. Effect of procalcitonin-guidedantibiotic treatment on mortality in acute respiratory infections: apatient level meta-analysis. Lancet Infect Dis. 2018;18(1):95-107.Available in: https://doi.org/10.1016/S1473-3099(17)30592-3

  6. Papp M, Kiss N, Baka M, et al. Procalcitonin-guided antibiotictherapy may shorten length of treatment and may improvesurvival-a systematic review and meta-analysis. Crit Care.2023;27(1):394. Available in: https://doi.org/10.1186/s13054-023-04677-2

  7. Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, et al.Procalcitonin to reduce long-term infection-associated adverseevents in sepsis. a randomized trial. Am J Respir Crit CareMed. 2021;203(2):202-210. Available in: https://doi.org/10.1164/rccm.202004-1201OC

  8. Moreno RP, Metnitz PG, Almeida E, et al. SAPS 3--Fromevaluation of the patient to evaluation of the intensive care unit.Part 2: Development of a prognostic model for hospital mortalityat ICU admission. Intensive Care Med. 2005;31(10):1345-1355.Available in: https://doi.org/10.1007/s00134-005-2763-5

  9. World Medical Association Declaration of Helsinki. JAMA.2013;310:2191. Available in: https://doi.org/10.1001/jama.2013.281053

  10. Wang X, Long Y, Su L, Zhang Q, Shan G, He H. Usingprocalcitonin to guide antibiotic escalation in patients withsuspected bacterial infection: a new application of procalcitoninin the Intensive Care Unit. Front Cell Infect Microbiol.2022;12:844134. Available in: https://doi.org/10.3389/fcimb.2022.844134

  11. Jeon K, Suh JK, Jang EJ, et al. Procalcitonin-guided treatmenton duration of antibiotic therapy and cost in septic patients(PRODA): a multi-center randomized controlled trial. J KoreanMed Sci. 2019;34(14):e110. Available in: https://doi.org/10.3346/jkms.2019.34.e110

  12. Robert A, Perriens E, Blackman S, et al. In sepsis, procalcitoninguidedantibiotic discontinuation strategies may be beneficialand safe: beware of potential confounders. Crit Care Med.2025;53:e523-e524. Available in: https://doi.org/10.1097/CCM.0000000000006502

  13. Kim JH. Clinical utility of procalcitonin on antibiotic stewardship: anarrative review. Infect Chemother. 2022;54:610-620. Availablein: https://doi.org/10.3947/ic.2022.0162

  14. Lambden S, Laterre PF, Levy MM, Francois B. The SOFA scoredevelopment,utility and challenges of accurate assessment inclinical trials. Crit Care. 2019;23(1):374. Available in: https://doi.org/10.1186/s13054-019-2663-7

  15. De Jong E, van Oers JA, Beishuizen A, et al. Efficacy and safetyof procalcitonin guidance in reducing the duration of antibiotictreatment in critically ill patients: a randomised, controlled, openlabeltrial. Lancet Infect Dis. 2016;16(7):819-827. Available in:https://doi.org/10.1016/S1473-3099(16)00053-0




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