Evidence map›Paper›PMID 29037960›Full record

SynthesisThe Lancet. Infectious diseases2018

Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis.

Philipp Schuetz, Yannick Wirz, Ramon Sager, Mirjam Christ-Crain, Daiana Stolz, Michael Tamm, Lila Bouadma, Charles E Luyt, Michel Wolff, Jean Chastre and 30 more

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in The Lancet. Infectious diseases, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 210 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
210citing papers in PubMed, 12 pooled it
33.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

210 citing papers in PubMed, 12 syntheses or guidelines pooled it, 459 citations in OpenAlex.

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  2. Efficacy and Safety of Procalcitonin-Guided Antibiotic Therapy versus Standard of Care for Sepsis: A Systematic Review and Meta-Analysis.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2026
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150 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

40 authors at 20 institutions in 13 countries.

Philipp SchuetzMedical University Department, Kantonsspital Aarau, Aarau, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland. Electronic address: schuetzph@gmail.com.
Yannick WirzMedical University Department, Kantonsspital Aarau, Aarau, Switzerland.
Ramon SagerMedical University Department, Kantonsspital Aarau, Aarau, Switzerland.
Mirjam Christ-CrainFaculty of Medicine, University of Basel, Basel, Switzerland; Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Basel, Switzerland.
Daiana StolzFaculty of Medicine, University of Basel, Basel, Switzerland; Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland.
Michael TammFaculty of Medicine, University of Basel, Basel, Switzerland; Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland.
Lila BouadmaService de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France.
Charles E LuytService de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, Paris, France.
Michel WolffService de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France.
Jean ChastreService de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, Paris, France.
Florence TubachDépartement de Biostatistique, Santé publique et Information médicale, AP-HP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Sorbonne Universités, Paris, France.
Kristina B KristoffersenDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
Olaf BurkhardtDepartment of Pulmonary Medicine, Medizinische Hochschule Hannover, Member of the German Center of Lung Research, Hannover, Germany.
Tobias WelteDepartment of Pulmonary Medicine, Medizinische Hochschule Hannover, Member of the German Center of Lung Research, Hannover, Germany.
Stefan SchroederDepartment of Anesthesiology and Intensive Care Medicine, Krankenhaus Dueren, Dueren, Germany.
Vandack NobreDepartment of Intensive Care, Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Long WeiDepartment of Internal and Geriatric Medicine, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China.
Heiner C BucherFaculty of Medicine, University of Basel, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
Djillali AnnaneCritical Care Department, Hôpital Raymond Poincaré, AP-HP, Faculty of Health Science Simone Veil, UVSQ-University Paris Saclay, Garches, France.
Konrad ReinhartDepartment of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
Ann R FalseyDepartment of Medicine, University of Rochester, Rochester, NY, USA.
Angela BrancheDepartment of Medicine, University of Rochester, Rochester, NY, USA.
Pierre DamasDepartment of General Intensive Care, University Hospital of Liege, Domaine Universitaire de Liège, Liège, Belgium.
Maarten NijstenUniversity Medical Centre, University of Groningen, Groningen, Netherlands.
Dylan W de LangeUniversity Medical Center Utrecht and University of Utrecht, Utrecht, Netherlands.
Rodrigo O DeliberatoCritical Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Carolina F OliveiraDepartment of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Vera Maravić-StojkovićImmunology Laboratory, Dedinje Cardiovascular Institute, Belgrade, Serbia.
Alessia VerduriSection of Respiratory Medicine, Department of Medical and Surgical Sciences, University Polyclinic of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Bianca BeghéSection of Respiratory Medicine, Department of Medical and Surgical Sciences, University Polyclinic of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Bin CaoCenter for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.
Yahya ShehabiCritical Care and Peri-operative Medicine, Monash Health, Melbourne, VIC, Australia; School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
Jens-Ulrik S JensenCentre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases and Rheumatology, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Caspar CortiDepartment of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
Jos A H van OersElisabeth Tweesteden Hospital, Tilburg, Netherlands.
Albertus BeishuizenMedisch Spectrum Twente, Enschede, Netherlands.
Armand R J GirbesVUmc University Medical Center, Amsterdam, Netherlands.
Evelien de JongVUmc University Medical Center, Amsterdam, Netherlands.
Matthias BrielFaculty of Medicine, University of Basel, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Beat MuellerMedical University Department, Kantonsspital Aarau, Aarau, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
University Hospital of Basel · CHAmsterdam UMC Location VUmc · NLAssistance Publique – Hôpitaux de Paris · FRDélégation Paris 7 · FRKantonsspital Aarau · CHMedizinische Hochschule Hannover · DESorbonne Université · FRUniversity of Basel · CHUniversity of Modena and Reggio Emilia · ITUniversity of Rochester · USAarhus University Hospital · DKBispebjerg Hospital · DKCentre Hospitalier Universitaire de Liège · BEChina-Japan Friendship Hospital · CNElisabeth-TweeSteden Ziekenhuis · NLHospital das Clínicas da Universidade Federal de Minas Gerais · BRHospital Israelita Albert Einstein · BRInstitute for Cardiovascular Diseases of Vojvodina · RSJena University Hospital · DEKrankenhaus Düren · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn February, 2017, the US Food and Drug Administration approved the blood infection marker procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety of procalcitonin-guided treatment in patients with acute respiratory infections from different clinical settings.

methodsBased on a prespecified Cochrane protocol, we did a systematic literature search on the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, and pooled individual patient data from trials in which patients with respiratory infections were randomly assigned to receive antibiotics based on procalcitonin concentrations (procalcitonin-guided group) or control. The coprimary endpoints were 30-day mortality and setting-specific treatment failure. Secondary endpoints were antibiotic use, length of stay, and antibiotic side-effects.

findingsWe identified 990 records from the literature search, of which 71 articles were assessed for eligibility after exclusion of 919 records. We collected data on 6708 patients from 26 eligible trials in 12 countries. Mortality at 30 days was significantly lower in procalcitonin-guided patients than in control patients (286 [9%] deaths in 3336 procalcitonin-guided patients vs 336 [10%] in 3372 controls; adjusted odds ratio [OR] 0·83 [95% CI 0·70 to 0·99], p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (p

interpretationUse of procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance.

fundingNational Institute for Health Research.

Indexed as

AdultAgedAged, 80 and overAnti-Bacterial AgentsBacterial InfectionsDrug-Related Side Effects and Adverse ReactionsFemaleHumansLength of StayMaleMiddle AgedProcalcitoninRandomized Controlled Trials as TopicRespiratory Tract InfectionsSurvival AnalysisAnti-Bacterial AgentsProcalcitonin

Identifiers

PMID29037960
OpenAlexW2761236748

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.