Procalcitonin as a Biomarker in Rhinosinusitis: A Systematic Review

Amanda E. Dilger, Anju T. Peters, Richard G. Wunderink, Bruce K. Tan, Robert C. Kern, David B. Conley, Kevin C. Welch, Jane L. Holl, Stephanie Shintani Smith*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)103-112
Number of pages10
JournalAmerican Journal of Rhinology and Allergy
Issue number2
StatePublished - Mar 1 2019


  • acute rhinosinusitis
  • biomakers
  • procalcitonin
  • systematic review

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

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