Song Gwan Gyu, Bae Sang-Cheol, Lee Young Ho
Division of Rheumatology, Department of Internal Medicine, Korea University College of Medicine, Hanyang University Medical Centre, Seoul, Korea.
Division of Rheumatology, Department of Internal Medicine, The Hospital for Rheumatic Diseases, Hanyang University Medical Centre, Seoul, Korea.
Clin Exp Rheumatol. 2015 Mar-Apr;33(2):166-73. Epub 2015 Jan 20.
The purpose of this study was to compare the diagnostic performance of procalcitonin and C-reactive protein (CRP) for bacterial infection in patients with systemic rheumatic diseases.
We searched Medline, Embase, and the Cochran library, and performed two meta-analyses on the diagnostic accuracy of procalcitonin and CRP for bacterial infection in systemic rheumatic disease patients.
A total of eight studies including 668 patients in whom the patients with bacterial infection were 208 were available for the meta-analysis. The pooled sensitivity and specificity of procalcitonin were 66.8% (95% confidence interval [CI] 60.0-73.2) and 89.8% (86.6-92.4), respectively, and those of CRP were 81.3% (75.3-86.3) and 63.0% (58.5-67.5). Procalcitonin PLR, NLR, and DOR were 5.930 (3.593-9.786), 0.352 (0.229-0.539), and 19.33 (10.25-36.45), respectively, and those for CRP were 2.228 (1.376-3.608), 0.367 (0.252-0.534), and 7.066 (3.559-14.03), respectively. The AUC of procalcitonin was 0.884 and the Q* index was 0.814, while the AUC of CRP was 0.789 and the Q* index was 0.726, which indicated that the diagnostic accuracy of procalcitonin in patients with systemic rheumatic diseases is higher than that of CRP (difference of AUC 0.095, 95% CI 0.004-0.185, p=0.039). When the data were limited to SLE, the specificity of procalcitonin was also significantly higher than that of CRP (difference 0.219, 95% CI 0.127-0.310, p<0.0001).
Our meta-analysis of published studies demonstrates that procalcitonin is more specific and has better diagnostic accuracy than CRP for bacterial infection in systemic rheumatic diseases.
本研究旨在比较降钙素原和C反应蛋白（CRP）对系统性风湿性疾病患者细菌感染的诊断性能。
我们检索了Medline、Embase和Cochrane图书馆，并对降钙素原和CRP对系统性风湿性疾病患者细菌感染的诊断准确性进行了两项荟萃分析。
共有八项研究，包括668例患者，其中细菌感染患者208例，可用于荟萃分析。降钙素原的合并敏感性和特异性分别为66.8%（95%置信区间[CI]60.0 - 73.2）和89.8%（86.6 - 92.4），CRP的合并敏感性和特异性分别为81.3%（75.3 - 86.3）和63.0%（58.5 - 67.5）。降钙素原的阳性似然比（PLR）、阴性似然比（NLR）和诊断比值比（DOR）分别为5.930（3.593 - 9.786）、0.352（0.229 - 0.539）和19.33（10.25 - 36.45），CRP的分别为2.228（1.376 - 3.608）、0.367（0.252 - 0.534）和7.066（3.559 - 14.03）。降钙素原的曲线下面积（AUC）为0.884，Q指数为0.814，而CRP的AUC为0.789，Q指数为0.726，这表明降钙素原对系统性风湿性疾病患者的诊断准确性高于CRP（AUC差异为0.095，95%CI为0.004 - 0.185，p = 0.039）。当数据仅限于系统性红斑狼疮（SLE）时，降钙素原的特异性也显著高于CRP（差异为0.219，95%CI为0.127 - 0.310，p < 0.0001）。
我们对已发表研究的荟萃分析表明，在系统性风湿性疾病中，降钙素原对细菌感染的诊断比CRP更具特异性且诊断准确性更高。
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