Clinical effectiveness of procalcitonin-based protocols to initiate or discontinue antibiotics in patients presenting with acute exacerbations of COPD
| Outcomes | No of participants (studies) Follow-up | Quality of the evidence (GRADE) | Relative effect (95% CI) | Anticipated absolute effects | |
|---|---|---|---|---|---|
| Risk with standard care | Risk difference with Procalcitonin-guided protocols | ||||
| Treatment failure for the index exacerbation. | 834 (5 RCTs) | ⊕⊕○○ LOW 1,2 | RR 0.81 (0.62 to 1.06) | 206 per 1,000 | 39 fewer failures per 1,000 (78 fewer to 12 more) |
| Length of hospital stay for the index exacerbation | 1062 (8 RCTs) | ⊕⊕⊕○ MODERATE 1 | MD −0.76(−1.95 to 0.43) | Mean length of hospital stay was 8.55 days | MD 0.76 days lower (1.95 lower to 0.43 higher) |
| Proportion of patients who were prescribed antibiotics on admission | 984 (7 RCTs) | ⊕⊕⊕○ MODERATE 1 | RR 0.56 (0.43 to 0.73) | 791 per 1,000 | 348 fewer prescriptions per 1,000 (451 fewer to 214 fewer) |
| Mean duration of the course of antibiotics | 776 (6 RCTs) | ⊕⊕○○ LOW 1,2 | MD −3.83 (−4.32 to −3.35) | Mean duration of course of antibiotics was 8.27 days | MD 3.83 days lower (4.32 lower to 3.35 lower) |
| Exacerbation recurrence rate at longest follow-up | 496 (3 RCTs) | ⊕⊕○○ LOW 1,2 | RR 0.96 (0.69 to 1.35) | 205 per 1,000 | 8 fewer recurrences per 1,000 (63 fewer to 72 more) |
| Re-hospitalisation rate at longest follow-up | 398 (3 RCTs) | ⊕⊕○○ LOW 1,2 | RR 1.45 (0.92 to 2.29) | 116 per 1,000 | 52 more admissions per 1,000 (9 fewer to 150 more) |
| Rate of re-hospitalisation due to an exacerbation at longest follow up | 298 (2 RCTs) | ⊕⊕○○ LOW 1,2 | RR 1.22 (0.71 to 2.09) | 135 per 1,000 | 30 more admissions per 1,000 (39 fewer to 147 more) |
| Overall mortality at longest follow up | 1062 (8 RCTs) | ⊕⊕○○ LOW 1,2 | RR 0.99 (0.57 to 1.70) | 41 per 1,000 | 0 fewer deaths per 1,000 (18 fewer to 29 more) |
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; MD: Mean difference.