An important negative study of an inflammatory biomarker that's been getting a fair amount of push.
It is absolutely true that procalcitonin levels may be elevated in an inflammatory states such as sepsis. This group tried to make a clinically relevant protocol for procalcitonin trends by saying, if the procalcitonin level is not decreasing with current therapy, then antibiotic coverage should be expanded and aggressive testing should be undertaken to evaluate for missed source control.
Unfortunately, in the treatment arm where procalcitonin was used in clinical decision making, there was extensively greater broad-spectrum and multiple-antibiotic utilization without any demonstrated mortality benefit. In addition, LOS and ventilator-depended days were longer in the procalcitonin arm.
There were very minor differences between the two groups, probably favoring the control, but not nearly enough to suggest that procalcitonin has any value in assessing failure of current therapy.
http://www.ncbi.nlm.nih.gov/pubmed/21572328
