Meta-analysis and systematic review of procalcitonin-guided treatment in acute exacerbation of chronic obstructive pulmonary disease

Abstract

Introduction: To evaluate the method of procalcitonin (PCT)-guided treatment on antibiotics in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: Database including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trails were searched to find relevant trails. Randomized and quasi-randomized trials of PCT-guided treatment in adult patients with AECOPD were included. Effects on primary outcome (i.e., antibiotic prescriptions, mortality, and clinical success) were accessed in this meta-analysis. Results: Four trials involving 679 patients were included. PCT-guided treatment significantly reduced antibiotic use (OR 0.26, 95% CI 0.14–0.50, P < 0.0001) in comparison to standard treatment, without increasing clinical failure (OR 1.10, 95% CI 0.70–1.74, P = 0.68; I2 = 0%) and mortality (OR 0.86, 95% CI 0.44–1.68, P = 0.66). The rate of readmission and exacerbation at follow-up period was similar in both groups. Conclusion: Results from this meta-analysis suggest PCT-guided treatment can safely reduce antibiotic overuse in patients with AECOPD.