SynthesisCritical care (London, England)2018
Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials.
Synthesis in Critical care (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04203524 (Impact of a Procalcitonin-Guided Algorithm on Antimicrobial Utilization in Critically Ill Cancer Patients with Sepsis), which is not on this map. Cited by 109 papers, 7 of them syntheses that pooled 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.
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.
Impact of a Procalcitonin-Guided Algorithm on Antimicrobial Utilization in Critically Ill Cancer Patients with Sepsis: a Randomized Controlled Study (Pro-Can)
Who cites it
109 citing papers in PubMed, 7 syntheses or guidelines pooled it, 259 citations in OpenAlex.
- Mortality Associated with Intensive Care Unit Admission and Mechanical Ventilation in Adults with Acute Chest Syndrome: A Systematic Review.Medicina (Kaunas, Lithuania) · 2026Pooled it
- Pooled it
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- Procalcitonin-guided antibiotic treatment in patients with cancer: a patient-level meta-analysis from randomized controlled trials.BMC cancer · 2024Pooled it
- Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials.Age and ageing · 2021Pooled it
- Pooled it
- Procalcitonin levels in candidemia versus bacteremia: a systematic review.Critical care (London, England) · 2019Pooled it
- Procalcitonin testing combined with NEWS2 evaluation compared with usual care based on NEWS2 for identification of sepsis and antibiotic initiation in the emergency department in England and Wales (PRONTO): a multicentre, randomised, controlled, open-label, phase 3 trial.The Lancet. Respiratory medicine · 2026Trial
- Trial
- Procalcitonin to Reduce Long-Term Infection-associated Adverse Events in Sepsis. A Randomized Trial.American journal of respiratory and critical care medicine · 2021Trial
- Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers.Critical care (London, England) · 2020Trial
- The PRECISE framework: a structured approach to antibiogram interpretation for antimicrobial optimization at the bedside.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Review
- Risk factors associated with apyrexia during bacteraemia: a prospective multicenter cohort study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Using interpretable machine learning to analyze the trajectory changes of serum albumin to predict the mortality rate of sepsis: a cohort study based on MIMIC-IV.BMC infectious diseases · 2026Article
- Individualized antibiotic therapy in patients with ventilator-associated pneumonia in the intensive care unit.BMC anesthesiology · 2026Article
- Beyond the algorithm: reframing biomarker-guided antibiotic stewardship with behavioural insights.The Journal of antimicrobial chemotherapy · 2026Article
- Challenges in Antimicrobial Treatment and Antimicrobial Stewardship in Hospital-Acquired Infections in Adult Burn Patients.European burn journal · 2026Review
- Interleukin-6 in Daily Use in the Intensive Care Unit: Does It Change the Patients' Outcome and Antimicrobial Prescription? An Explorative Study.Life (Basel, Switzerland) · 2026Article
- Baseline Procalcitonin Levels and Their Association with Antibiotic Exposure and Clinical Outcomes in Critically Ill Patients with Suspected Bacterial Infection: A Retrospective Cohort Study.Healthcare (Basel, Switzerland) · 2026Article
- Stress hyperglycemia ratio in risk stratification and treatment optimization for patients on invasive mechanical ventilation: a secondary analysis of the MIMIC-IV database.BMC infectious diseases · 2026Article
49 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
24 authors at 17 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe clinical utility of serum procalcitonin levels in guiding antibiotic treatment decisions in patients with sepsis remains unclear. This patient-level meta-analysis based on 11 randomized trials investigates the impact of procalcitonin-guided antibiotic therapy on mortality in intensive care unit (ICU) patients with infection, both overall and stratified according to sepsis definition, severity, and type of infection.
methodsFor this meta-analysis focusing on procalcitonin-guided antibiotic management in critically ill patients with sepsis of any type, in February 2018 we updated the database of a previous individual patient data meta-analysis which was limited to patients with respiratory infections only. We used individual patient data from 11 trials that randomly assigned patients to receive antibiotics based on procalcitonin levels (the "procalcitonin-guided" group) or the current standard of care (the "controls"). The primary endpoint was mortality within 30 days. Secondary endpoints were duration of antibiotic treatment and length of stay.
resultsMortality in the 2252 procalcitonin-guided patients was significantly lower compared with the 2230 control group patients (21.1% vs 23.7%; adjusted odds ratio 0.89, 95% confidence interval (CI) 0.8 to 0.99; p = 0.03). These effects on mortality persisted in a subgroup of patients meeting the sepsis 3 definition and based on the severity of sepsis (assessed on the basis of the Sequential Organ Failure Assessment (SOFA) score, occurrence of septic shock or renal failure, and need for vasopressor or ventilatory support) and on the type of infection (respiratory, urinary tract, abdominal, skin, or central nervous system), with interaction for each analysis being > 0.05. Procalcitonin guidance also facilitated earlier discontinuation of antibiotics, with a reduction in treatment duration (9.3 vs 10.4 days; adjusted coefficient -1.19 days, 95% CI -1.73 to -0.66; p < 0.001).
conclusionProcalcitonin-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and lower antibiotic treatment duration.
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Registered trials
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.