Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.
Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.
Clin Microbiol Infect. 2015 May;21(5):474-81. doi: 10.1016/j.cmi.2014.12.026. Epub 2015 Jan 14.
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.
降钙素原在细菌性感染中的诊断作用仍存在争议。大多数研究使用不明确的结局指标，如败血症，而不是感染。我们进行了系统评价和荟萃分析，以调查降钙素原对菌血症的诊断准确性，菌血症是一种已证实的血流感染。我们从成立到 2014 年 6 月，在所有主要数据库中搜索了研究降钙素原和成人患者血培养阳性之间诊断准确性的原始英文研究文章。我们计算了汇总受试者工作特征（SROC）曲线下的面积，并汇总了敏感性和特异性。为了最大限度地减少潜在的异质性，我们进行了亚组分析。共有 1567 项符合条件的研究中有 58 项被纳入荟萃分析，共纳入 16514 名患者，其中 3420 名患有菌血症。在总体分析中，SROC 曲线下的面积为 0.79。最常用的最佳降钙素原截断值为 0.5ng/ml，相应的敏感性为 76%，特异性为 69%。在亚组分析中，免疫功能低下/中性粒细胞减少患者的 SROC 曲线下面积最低（0.71），重症监护患者的 SROC 曲线下面积最高（0.88），敏感性范围为 66%至 89%，特异性为 55%至 78%。尽管研究存在异质性，但降钙素原对怀疑感染或败血症的成年患者菌血症的诊断准确性仍较好。特别是低降钙素原水平可用于排除菌血症的存在。需要进一步研究降钙素原作为一种避免血培养的单一诊断工具的安全性和有效性。
