Liu Dan, Su Longxiang, Han Gencheng, Yan Peng, Xie Lixin
Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China; Medical School, Nankai University, 94 Weijin Road, Tianjin, 300071, China; Department of Respiratory Medicine, Tianjin Medical University General Hospital, Tianjin, 300070, China.
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100005, China.
PLoS One. 2015 Jun 15;10(6):e0129450. doi: 10.1371/journal.pone.0129450. eCollection 2015.
Procalcitonin (PCT) has been widely investigated for its prognostic value in septic patients. However, studies have produced conflicting results. The purpose of the present meta-analysis is to explore the diagnostic accuracy of a single PCT concentration and PCT non-clearance in predicting all-cause sepsis mortality. We searched PubMed, Embase, Web of Knowledge and the Cochrane Library. Articles written in English were included. A 2 × 2 contingency table was constructed based on all-cause mortality and PCT level or PCT non-clearance in septic patients. Two authors independently evaluated study eligibility and extracted data. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. We used the Q-test and I2 index to test heterogeneity. Twenty-three studies with 3,994 patients were included. An elevated PCT level was associated with a higher risk of death. The pooled relative risk (RR) was 2.60 (95% confidence interval (CI), 2.05-3.30) using a random-effects model (I(2) = 63.5%). The overall area under the summary receiver operator characteristic (SROC) curve was 0.77 (95% CI, 0.73-0.80), with a sensitivity and specificity of 0.76 (95% CI, 0.67-0.82) and 0.64 (95% CI, 0.52-0.74), respectively. There was significant evidence of heterogeneity for the PCT testing time (P = 0.020). Initial PCT values were of limited prognostic value in patients with sepsis. PCT non-clearance was a prognostic factor of death in patients with sepsis. The pooled RR was 3.05 (95% CI, 2.35-3.95) using a fixed-effects model (I(2) = 37.9%). The overall area under the SROC curve was 0.79 (95% CI, 0.75-0.83), with a sensitivity and specificity of 0.72 (95% CI, 0.58-0.82) and 0.77 (95% CI, 0.55-0.90), respectively. Elevated PCT concentrations and PCT non-clearance are strongly associated with all-cause mortality in septic patients. Further studies are needed to define the optimal cut-off point and the optimal definition of PCT non-clearance for accurate risk assessment.
降钙素原（PCT）在脓毒症患者中的预后价值已得到广泛研究。然而，研究结果相互矛盾。本荟萃分析的目的是探讨单一PCT浓度和PCT清除率在预测全因性脓毒症死亡率方面的诊断准确性。我们检索了PubMed、Embase、Web of Knowledge和Cochrane图书馆。纳入英文撰写的文章。根据脓毒症患者的全因死亡率和PCT水平或PCT清除率构建2×2列联表。两位作者独立评估研究的合格性并提取数据。使用双变量荟萃分析模型确定PCT预测预后的诊断价值。我们使用Q检验和I²指数检验异质性。纳入了23项研究，共3994例患者。PCT水平升高与死亡风险较高相关。使用随机效应模型时，合并相对风险（RR）为2.60（95%置信区间（CI），2.05 - 3.30）（I² = 63.5%）。汇总受试者工作特征（SROC）曲线下的总面积为0.77（95% CI，0.73 - 0.80），敏感性和特异性分别为0.76（95% CI，0.67 - 0.82）和0.64（95% CI，0.52 - 0.74）。PCT检测时间存在显著异质性证据（P = 0.020）。初始PCT值在脓毒症患者中的预后价值有限。PCT清除率是脓毒症患者死亡的一个预后因素。使用固定效应模型时，合并RR为3.05（95% CI，2.35 - 3.95）（I² = 37.9%）。SROC曲线下总面积为0.79（95% CI，0.75 - 0.83），敏感性和特异性分别为0.72（95% CI，0.58 - 0.82）和0.77（95% CI，0.55 - 0.90）。PCT浓度升高和PCT清除率与脓毒症患者的全因死亡率密切相关。需要进一步研究来确定准确风险评估的最佳截断点和PCT清除率的最佳定义。
