The role of Procalcitonin in the management of patients with sepsis and respiratory tract infections: from bench to bedside

SUMMARY. Sepsis constitutes a clinical syndrome with complex pathophysiological mechanisms, and it is leading cause of mortality in intensive care units (ICUs) worldwide. Guidelines and recommendations published during the last decade have emphasized the need for early recognition and management of patients with sepsis, including timely antibiotic administration. The use of biomarkers such as procalcitonin (PCT), to help in the timely recognition and effective management of sepsis, employed either alone or as a part of a multi-dimensional model, represents one of the contemporary challenges of pulmonary and critical care medicine. Respiratory tract infections represent a significant burden in critical care settings, being a major reason for antibiotic consumption and a major cause of morbidity and mortality. Recent evidence derived from published studies, systematic reviews and meta-analyses supports the use of PCT as a marker for the selection of those patients with lower respiratory tract infections who need antibiotics, both in the ICU setting and in the ward, but with significant inconsistencies. This review aims to cover briefly the rationale for the use of PCT as a biomarker in patients with sepsis, especially those presenting with lower respiratory tract infections, and to provide insights into the possible use of this biomarker in everyday clinical practice. Pneumon 2010, 23(4):369-375.