1Department of Internal Medicine, University Hospital of Patras, Patras, Greece.
21st Department of Internal medicine ,,G. Gennimatas General Hospital, Athens, Greece.
Rom J Intern Med. 2024 Mar 27;62(3):241-259. doi: 10.2478/rjim-2024-0013. Print 2024 Sep 1.
Biomarker-based clinical practice is currently gaining ground and increasingly affects decision making. A variety of biomarkers have been studied through the years and some of them have already an established role in modern medicine, such as procalcitonin (PCT) which has been proposed to reduce antibiotic exposure. We purposed to systematically review all biomarkers examined for guiding the clinical practice in patients with pneumonia.
A systematic review on PubMed was performed on April 2023 by two independent researchers using the PRISMA guidelines. Randomized trials which enrolled patients with pneumonia and compared biomarker-guided strategies to standard of care were included.
1242 studies were recorded, from whom 16 were eligible for this study. 14 studies investigated PCT as a biomarker. From these, 8 studies reported on community acquired pneumonia (CAP), 2 on ventilator associated pneumonia (VAP), 1 on aspiration pneumonia, 1 on hospital acquired pneumonia (HAP) and 2 on exacerbation of chronic obstructive pulmonary disease (ECOPD). There was 1 study, referred to VAP, that investigated interleukin-1β (IL-1β) and interleukin-8 (IL-8) and 1 study that reported the role of C-reactive protein (CRP) in ECOPD. In a total of 4751 patients in 15 studies, the biomarker-based approach did not lead to increased mortality [OR: 0.998 (95%CI: 0.74-1.34, p value: 0.991). I2:19%]. Among different types of pneumonia and time-points of assessment, biomarker-guided practice appeared to improve antibiotic-related outcomes, such as rate of antibiotic prescription, duration of antibiotic therapy and rate of antibiotic exposure, while 5 studies reported a possible decrease in antibiotic-related adverse effects. Biomarker-guided practice did not seem to lead in an increase in other adverse outcomes such as need for hospitalization and duration of hospitalization. However, the included studies have high risk of bias mainly due to improper blinding of participants/personnel and outcome assessors.
Biomarker-guided clinical practice improves provided healthcare, in terms of reduced antibiotic consumption with no inferiority to mortality, relapses and exacerbations in patients with different types of pneumonia. Thus, such approaches should be further evaluated to achieve personalized medicine.
系统评价所有用于指导肺炎患者临床实践的生物标志物。
2023 年 4 月，两名独立研究者按照 PRISMA 指南在 PubMed 上进行了系统评价。纳入比较生物标志物指导策略与标准护理的肺炎患者的随机试验。
共记录了 1242 项研究，其中 16 项符合本研究的条件。14 项研究将降钙素原 (PCT) 作为生物标志物进行了研究。其中，8 项研究报告了社区获得性肺炎 (CAP)，2 项研究报告了呼吸机相关性肺炎 (VAP)，1 项研究报告了吸入性肺炎，1 项研究报告了医院获得性肺炎 (HAP)，2 项研究报告了慢性阻塞性肺疾病急性加重 (ECOPD)。有 1 项关于 VAP 的研究调查了白细胞介素-1β (IL-1β) 和白细胞介素-8 (IL-8)，1 项研究报告了 C 反应蛋白 (CRP) 在 ECOPD 中的作用。在 15 项研究的 4751 例患者中，基于生物标志物的方法并未导致死亡率增加[比值比：0.998(95%置信区间：0.74-1.34，p 值：0.991)。I2：19%]。在不同类型的肺炎和评估时间点中，生物标志物指导实践似乎改善了抗生素相关结局，如抗生素处方率、抗生素治疗持续时间和抗生素暴露率，而 5 项研究报告了抗生素相关不良事件可能减少。生物标志物指导实践似乎不会导致其他不良结局增加，如住院需求和住院时间。然而，纳入的研究主要由于对参与者/人员和结局评估者的不当盲法，存在高偏倚风险。
生物标志物指导的临床实践改善了不同类型肺炎患者的医疗服务，减少了抗生素的使用，且死亡率、复发率和加重率无差异。因此，应进一步评估此类方法，以实现个体化医疗。
