Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: a patient-level meta-analysis from randomized controlled trials.

Abstract

Objectives:

Patients with impaired kidney function have a significantly slower decrease of procalcitonin (PCT) levels during infection. Our aim was to study PCT-guided antibiotic stewardship and clinical outcomes in patients with impairments of kidney function as assessed by creatinine levels measured upon hospital admission.

Methods:

We pooled and analyzed individual data from 15 randomized controlled trials who were randomly assigned to receive antibiotic therapy based on a PCT-algorithms or based on standard of care. We stratified patients on the initial glomerular filtration rate (GFR, ml/min/1.73 m2) in three groups (GFR >90 [chronic kidney disease; CKD 1], GFR 15-89 [CKD 2-4] and GFR<15 [CKD 5]). The main efficacy and safety endpoints were duration of antibiotic treatment and 30-day mortality.

Results:

Mean duration of antibiotic treatment was significantly shorter in PCT-guided (n=2,492) compared to control patients (n=2,510) (9.5-7.6 days; adjusted difference in days -2.01 [95% CI, -2.45 to -1.58]). CKD 5 patients had overall longer treatment durations, but a 2.5-day reduction in treatment duration was still found in patients receiving in PCT-guided care (11.3 vs. 8.6 days [95% CI -3.59 to -1.40]). There were 397 deaths in 2,492 PCT-group patients (15.9%) compared to 460 deaths in 2,510 control patients (18.3%) (adjusted odds ratio, 0.88 [95% CI 0.78 to 0.98)]. Effects of PCT-guidance on antibiotic treatment duration and mortality were similar in subgroups stratified by infection type and clinical setting (p interaction >0.05).

Conclusions:

This individual patient data meta-analysis confirms that the use of PCT in patients with impaired kidney function, as assessed by admission creatinine levels, is associated with shorter antibiotic courses and lower mortality rates.

• Authors: Eva Heilmann, Claudia Gregoriano, Yannick Wirz, Charles-Edouard Luyt, Michel Wolff, Jean Chastre, Florence Tubach, Mirjam Christ-Crain, Lila Bouadma, Djillali Annane, Pierre Damas, Kristina B Kristoffersen, Carolina F Oliveira, Daiana Stolz, Michael Tamm, Evelien de Jong, Konrad Reinhart, Yahya Shehabi, Alessia Verduri, Vandack Nobre, Maarten Nijsten, Dylan W deLange, Jos A H van Oers, Albertus Beishuizen, Armand R J Girbes, Beat Mueller, Philipp Schuetz
• Journal: Clinical chemistry and laboratory medicine (Clin Chem Lab Med) Vol. 59 Issue 2 Pg. 441-453 (09 28 2020) ISSN: 1437-4331 [Electronic] Germany
• PMID: 32986609 (Publication Type: Journal Article, Meta-Analysis)

Chemical References

• Anti-Bacterial Agents
• Biomarkers
• Procalcitonin

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (therapeutic use)
• Antimicrobial Stewardship
• Biomarkers (blood)
• Drug Utilization
• Female
• Hospitalization
• Humans
• Kidney
• Length of Stay
• Male
• Middle Aged
• Mortality (ethnology)
• Practice Guidelines as Topic
• Procalcitonin (blood)
• Randomized Controlled Trials as Topic
• Renal Insufficiency, Chronic (mortality)
• Risk Assessment
• Time Factors
• Treatment Outcome