Critical Matters PCT Reassessed
Dec 11, 2025
Simran Gupta, an infectious disease specialist at Brigham and Women's Hospital, shares her expertise on procalcitonin (PCT) in the ICU. She delves into the biology and clinical applications of PCT, emphasizing its potential to reduce unnecessary antibiotic use. Gupta discusses the ADAPT-Sepsis trial, highlighting how it supports shorter antibiotic courses without compromising patient survival. She also addresses challenges clinicians face in discontinuing antibiotics and offers practical tips for effective PCT use in critical care, all while reflecting on personal growth and recommending the book 'Shantaram'.
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PCT Kinetics And Test Performance
- Procalcitonin rises within 2–4 hours, peaks by 24 hours, and declines rapidly as bacterial infection resolves.
- It has ~77–79% sensitivity and specificity, outperforming CRP and WBC for bacterial sepsis detection.
Don't Use PCT To Start Antibiotics
- Use procalcitonin to support stopping antibiotics, not to decide initial antibiotic starts.
- Reserve clinical judgment and other data for the decision to initiate empiric therapy.
Early Trials Were Mixed And Method-Limited
- Early ICU trials (ProGuard, SAPS, PROGRESS) focused on PCT-guided discontinuation and showed mixed results.
- Variable thresholds, low adherence, and open-label designs limited their conclusions.