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

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DOI

  • Eva Heilmann, Cantonal Hospital Aarau
  • ,
  • Claudia Gregoriano, Cantonal Hospital Aarau
  • ,
  • Yannick Wirz, Cantonal Hospital Aarau
  • ,
  • Charles Edouard Luyt, Sorbonne Université
  • ,
  • Michel Wolff, Université de Paris
  • ,
  • Jean Chastre, Université de Paris
  • ,
  • Florence Tubach, AP-HP Assistance Publique - Hopitaux de Paris
  • ,
  • Mirjam Christ-Crain, University of Basel
  • ,
  • Lila Bouadma, Université de Paris
  • ,
  • Djillali Annane, Hopital Raymond Poincare
  • ,
  • Pierre Damas, University of Liege
  • ,
  • Kristina B. Kristoffersen
  • ,
  • Carolina F. Oliveira, Universidade Federal de Minas Gerais
  • ,
  • Daiana Stolz, University of Basel
  • ,
  • Michael Tamm, University of Basel
  • ,
  • Evelien De Jong, Vrije Universiteit Amsterdam
  • ,
  • Konrad Reinhart, Friedrich Schiller University Jena, Leipzig University
  • ,
  • Yahya Shehabi, Critical Care and Peri-operative Medicine, Monash University
  • ,
  • Alessia Verduri, University of Modena and Reggio Emilia
  • ,
  • Vandack Nobre, Universidade Federal de Minas Gerais
  • ,
  • Maarten Nijsten, University of Groningen
  • ,
  • Dylan W. Delange, Utrecht University
  • ,
  • Jos A.H. Van Oers, ETZ Elisabeth - Tweesteden Ziekenhuis
  • ,
  • Albertus Beishuizen, Medisch Spectrum Twente
  • ,
  • Armand R.J. Girbes, Vrije Universiteit Amsterdam
  • ,
  • Beat Mueller, Cantonal Hospital Aarau, University of Basel
  • ,
  • Philipp Schuetz, Cantonal Hospital Aarau, University of Basel

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. 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. 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). 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.

OriginalsprogEngelsk
TidsskriftClinical Chemistry and Laboratory Medicine
Vol/bind59
Nummer2
Sider (fra-til)441-453
Antal sider13
ISSN1434-6621
DOI
StatusUdgivet - feb. 2021

Bibliografisk note

Funding Information:
Research funding: This research was supported by the Roche Diagnostics (KSA 2019 001).

Funding Information:
Competing interests: PS and BM report receiving grants from Thermofisher, Roche Diagnostics and BioMerieux. CEL received lecture fees from Thermofisher Brahms, BioMérieux. YS has received unrestricted research grants from Thermo-fisher, BioMérieux, Orion Pharma, and Pfizer. MCC, DS and MT have received research support from Thermo-Fisher. All other authors declare that they have no conflicts of interest. The National Institute for Health Research provided a grant for the initial Cochrane analysis. Roche Diagnostics provided an unrestricted research grant for this analysis. The funders of the study had no bearing on study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Publisher Copyright:
© 2020 Eva Heilmann et al., published by De Gruyter, Berlin/Boston.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

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