Procalcitonin and sepsis: recent data on diagnostic utility prognostic potential and therapeutic implications in critically ill patients.

Procalcitonin (PCT) has emerged as the most specific biomarker for bacterial infection. As clinicians become more familiar with its use, a multitude of observational studies have reported on its diagnostic potential in distinct types of infections and various clinical situations, such as in neutropenia or in the postoperative period. In the Intensive Care Unit setting, however, the prognostic value of a single PCT measurement at the time of admission on a patient with sepsis is suboptimal. Especially in cases of community-acquired pneumonia, cardiovascular biomarkers, such as mid-regional proadrenomedullin, seem to carry stronger prognostic potential than PCT. Nevertheless, the study of PCT kinetics may still be of use as a risk assessment tool for the general population of critically ill patients with sepsis syndrome. The most recent significant development in the field of PCT monitoring, is the publication of several randomized controlled trials that investigated its use as a decision making tool for the initiation and/or the duration of antibiotic treatment. Currently, the available evidence suggests that the incorporation of PCT measurements to assist with the duration of antibiotic stewardship programs may decrease antibiotic use without compromising clinical outcomes. Nevertheless, this strategy still needs further validation in large prospective studies.