Procalcitonin as a Biomarker in Rhinosinusitis: A Systematic Review. Issue 2 (March 2019)

• Record Type: Journal Article
• Authors: Dilger, Amanda E.; Peters, Anju T.; Wunderink, Richard G.; Tan, Bruce K.; Kern, Robert C.; Conley, David B.; Welch, Kevin C.; Holl, Jane L.; Smith, Stephanie Shintani
• Is Part Of: American journal of rhinology & allergy. Volume 33:Issue 2(2019)
• Page Start: 103
• Page End: 112
• Publication Date: 2019-03
• Subjects: procalcitonin -- biomakers -- acute rhinosinusitis -- systematic review; Nose -- Periodicals; Allergy -- Periodicals; 616.21005
• DOI: 10.1177/1945892418810293
• Languages: English
• ISSNs: 1945-8924

Abstract

Objectives: (1) To describe the existing literature on procalcitonin (PCT) as a biomarker in patients with acute rhinosinusitis (ARS), (2) to analyze outcomes in ARS patients who were treated with PCT-guided therapy versus traditional management, and (3) to compare PCT to other biomarkers used in diagnosis of bacterial ARS. Data Sources : PubMed and Embase. Review Methods : A systematic search in the PubMed and Embase databases was performed to identify studies related to PCT as a biomarker in ARS. After critical appraisal of validity by 2 authors, 6 studies with a total of 313 patients were selected for data extraction and analysis. We identified 2 randomized control trials (RCTs) of PCT-based guidelines for antibiotic management of ARS in outpatient settings and 4 observational studies that compared PCT to other biomarkers in patients with ARS. Results: The 2 RCTs demonstrated a reduction (41.6% in 1 study and 71% in the other) in antibiotic prescription rate in the PCT-guided group versus the control group with no change in the number of days with impaired activity due to illness (9.0 vs 9.0 days [ P = .96]; 8.1 vs 8.2 days [95% confidence interval −0.7 to 0.7]), number of days of work missed, and percentage of patients with persistent symptoms at 28 days. In the observational cohort studies, PCT did not consistently correlate with C-reactive protein, body temperature, and/or white blood cell counts. Conclusions: The limited existing literature on the role of PCT in diagnosis, management, and prediction of clinical outcomes in ARS suggests that PCT-based guidelines for antibiotic prescription are a safe and effective method of minimizing unnecessary antibiotic use.