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

doi:10.1177/1945892418810293

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 journal › Article › peer-review

9 Scopus citations

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.

Original language	English (US)
Pages (from-to)	103-112
Number of pages	10
Journal	American Journal of Rhinology and Allergy
Volume	33
Issue number	2
DOIs	https://doi.org/10.1177/1945892418810293
State	Published - Mar 1 2019

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported in part by the Northwestern University-Patient-centered Intervention and Engagement Training K12 Faculty Scholars Training Program, Grant Number K12HS023011 from the Agency for Healthcare Research and Quality, the National Institutes of Health’s Chronic Rhinosinusitis Integrative Studies Program, Grant Number U19 AI106683, and the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institutes of Health.

Keywords

acute rhinosinusitis
biomakers
procalcitonin
systematic review

ASJC Scopus subject areas

Immunology and Allergy
Otorhinolaryngology

Access to Document

10.1177/1945892418810293

Cite this

@article{1ab5164973254af6bdc7168041e5c600,

title = "Procalcitonin as a Biomarker in Rhinosinusitis: A Systematic Review",

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.",

keywords = "acute rhinosinusitis, biomakers, procalcitonin, systematic review",

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

note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported in part by the Northwestern University-Patient-centered Intervention and Engagement Training K12 Faculty Scholars Training Program, Grant Number K12HS023011 from the Agency for Healthcare Research and Quality, the National Institutes of Health{\textquoteright}s Chronic Rhinosinusitis Integrative Studies Program, Grant Number U19 AI106683, and the National Institutes of Health{\textquoteright}s National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institutes of Health. Publisher Copyright: {\textcopyright} The Author(s) 2018.",

year = "2019",

month = mar,

day = "1",

doi = "10.1177/1945892418810293",

language = "English (US)",

volume = "33",

pages = "103--112",

journal = "American Journal of Rhinology and Allergy",

issn = "1945-8924",

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T1 - Procalcitonin as a Biomarker in Rhinosinusitis

T2 - A Systematic Review

AU - Dilger, Amanda E.

AU - Peters, Anju T.

AU - Wunderink, Richard G.

AU - Tan, Bruce K.

AU - Kern, Robert C.

AU - Conley, David B.

AU - Welch, Kevin C.

AU - Holl, Jane L.

AU - Smith, Stephanie Shintani

N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported in part by the Northwestern University-Patient-centered Intervention and Engagement Training K12 Faculty Scholars Training Program, Grant Number K12HS023011 from the Agency for Healthcare Research and Quality, the National Institutes of Health’s Chronic Rhinosinusitis Integrative Studies Program, Grant Number U19 AI106683, and the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institutes of Health. Publisher Copyright: © The Author(s) 2018.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - 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.

AB - 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.

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Procalcitonin as a Biomarker in Rhinosinusitis: A Systematic Review

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