Meta‐analysis and systematic review of procalcitonin‐guided treatment in acute exacerbation of chronic obstructive pulmonary disease

Introduction To evaluate the method of procalcitonin (PCT)‐guided treatment on antibiotics in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Database including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trails were searched to find relevant trails. Randomized and quasi‐randomized trials of PCT‐guided treatment in adult patients with AECOPD were included. Effects on primary outcome (i.e., antibiotic prescriptions, mortality, and clinical success) were accessed in this meta‐analysis. Results Four trials involving 679 patients were included. PCT‐guided treatment significantly reduced antibiotic use (OR 0.26, 95% CI 0.14–0.50, P < 0.0001) in comparison to standard treatment, without increasing clinical failure (OR 1.10, 95% CI 0.70–1.74, P = 0.68; I 2 = 0%) and mortality (OR 0.86, 95% CI 0.44–1.68, P = 0.66). The rate of readmission and exacerbation at follow‐up period was similar in both groups. Conclusion Results from this meta‐analysis suggest PCT‐guided treatment can safely reduce antibiotic overuse in patients with AECOPD.