Usefulness of blood biomarker(s) to guide antibiotherapy for COPD exacerbations in primary care: systematic review of literature and meta-analysis

Background Acute Exacerbations of COPD (AECOPD) are frequently treated with antibiotics in primary care, leading to antibiotic resistance and adverse effects. Biomarkers might assist in reducing unnecessary antibiotic prescription when used alongside clinical assessment. Aim This review aimed to evaluate the benefit of point-of-care testing (POCT) biomarkers and lab blood tests in primary care in decreasing antibiotic prescriptions. Method This systematic review applied the PRISMA 2020 statement and the Cochrane Handbook to identify randomised controlled trials (RCTs) and observational studies conducted in primary care. The primary outcome was the rate of antibiotic prescribing or use, while secondary outcomes included biomarker threshold for prescription and patient harm. Searches were conducted in PubMed, CENTRAL, Embase, and Web of Science up to 31 August 2023. Data were extracted and assessed for quality and bias and meta-analysis performed using Cochrane RevMan® tool. Results Eight studies were included: six focused on CRP POCT and two on procalcitonin (PCT) lab testing. For CRP POCT, there was one RCT with 653 patients, four observational studies with 1854 patients, and one qualitative study. For PCT, two RCTs were included. The meta-analysis of CRP POCT indicated a significant reduction in antibiotic prescribing (OR = 0.41; 95% CI = 0.32 to −0.53; I 2 =36%) and low certainty of evidence. No meta-analysis for PCT was feasible. Conclusion CRP POCT likely reduces antibiotic prescriptions for AECOPD in primary care settings when used with clinical assessment. However, more RCTs are needed for confirmation. There is insufficient data to draw conclusions about PCT biomarker.