Efficacy and Safety of Procalcitonin-Guided Antibiotic Therapy versus Standard of Care for Sepsis: A Systematic Review and Meta-Analysis.

OBJECTIVES

This systematic review and meta-analysis assesses the efficacy and safety of procalcitonin (PCT)-guided therapy compared to the standard of care in septic patients.

METHODS

A comprehensive literature search was performed using the Cochrane Library, <ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, Embase, and MEDLINE, covering studies from their inception to April 2025. RevMan was used to perform a random effects meta-analysis, and forest plots were used to visualize the pooled estimates. The Mantel-Haenszel method was applied to analyze dichotomous outcomes. The inverse variance method was applied to analyze continuous outcomes.

RESULTS

Sixteen randomized controlled trials, with a total of 6,885 patients, were included. PCT-guided therapy was associated with significantly improved antibiotic treatment duration (standardized mean difference [SMD] -0.81, 95% confidence interval [CI]: -1.17 to -0.45, I2 97%), duration of mechanical ventilation (SMD -0.47, 95% CI: -0.57 to -0.37, I2 0%), and antibiotic-free days (SMD 0.14, 95% CI: 0.04-0.25, I2 0%). Both groups were comparable in terms of ICU mortality, hospital mortality, 30-day mortality, 90-day mortality, ICU stay, hospital stay, new infection, and clinical recovery. PCT was associated with greater reinfection (risk ratio 1.12, 95% CI: 1.00-1.26, I2 0%).

CONCLUSION

PCT-guided therapy was associated with shorter antibiotic treatment duration, though substantial heterogeneity was observed, while mortality outcomes were comparable between groups. Standardized PCT-based protocols are needed to improve consistency and clinical applicability.