Original article
Infectious diseases
The diagnostic accuracy of procalcitonin for bacteraemia: a systematic review and meta-analysis

https://doi.org/10.1016/j.cmi.2014.12.026Get rights and content
Under an Elsevier user license
open archive

Abstract

The diagnostic use of procalcitonin for bacterial infections remains a matter of debate. Most studies have used ambiguous outcome measures such as sepsis instead of infection. We performed a systematic review and meta-analysis to investigate the diagnostic accuracy of procalcitonin for bacteraemia, a proven bloodstream infection. We searched all major databases from inception to June 2014 for original, English language, research articles that studied the diagnostic accuracy between procalcitonin and positive blood cultures in adult patients. We calculated the area under the summary receiver-operating characteristic (SROC) curves and pooled sensitivities and specificities. To minimize potential heterogeneity we performed subgroup analyses. In total, 58 of 1567 eligible studies were included in the meta-analysis and provided a total of 16 514 patients, of whom 3420 suffered from bacteraemia. In the overall analysis the area under the SROC curve was 0.79. The optimal and most widely used procalcitonin cut-off value was 0.5 ng/mL with a corresponding sensitivity of 76% and specificity of 69%. In subgroup analyses the lowest area under the SROC curve was found in immunocompromised/neutropenic patients (0.71), the highest area under the SROC curve was found in intensive-care patients (0.88), sensitivities ranging from 66 to 89% and specificities from 55 78%. In spite of study heterogeneity, procalcitonin had a fair diagnostic accuracy for bacteraemia in adult patients suspected of infection or sepsis. In particular low procalcitonin levels can be used to rule out the presence of bacteraemia. Further research is needed on the safety and efficacy of procalcitonin as a single diagnostic tool to avoid taking blood cultures.

Keywords

Bacteraemia
diagnostic accuracy
infection
meta-analysis
procalcitonin
sensitivity and specificity

Abbreviations

AUC
area under the curve
PRISMA
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
QUADAS
Quality Assessment of Diagnostic Accuracy Studies
SIRS
systemic inflammatory response syndrome
SROC
summary receiver-operating characteristic

Cited by (0)

The authors Sandra H. Hoeboer and Patrick J. van der Geest contributed equally to this study