Yang Yongtao, Li Lianyong, Qu Changmin, Zeng Bolun, Liang Shuwen, Luo Zhiwen, Wang Xiaoying, Zhong Changqing
From the Department of Gastroenterology, The 306th Hospital of PLA, Chaoyang District, Beijing, China.
Medicine (Baltimore). 2015 Dec;94(49):e2077. doi: 10.1097/MD.0000000000002077.
Early diagnosis and prompt treatment of spontaneous bacterial peritonitis (SBP) due to end-stage liver disease is vital to shorten hospital stays and reduce mortality. Many studies have explored the potential usefulness of serum procalcitonin (PCT) in predicting SBP. The aim of this study is to evaluate the overall diagnostic accuracy of PCT levels for identifying SBP due to end-stage liver disease.After performing a systematic search of the Medline, Embase, and Cochrane databases for studies that evaluated the diagnostic role of PCT for SBP, sensitivity, specificity, and other measures of accuracy of PCT concentrations in serum for SBP diagnosis were pooled using random-effects models. A summary receiver operating characteristic curve was used to summarize overall test performance.Seven publications met the inclusion criteria covering 742 episodes of suspected SBP along with 339 confirmed cases. The summary estimates for serum PCT in the diagnosis of SBP attributable to end-stage liver disease were: sensitivity 0.82 (95% CI 0.79-0.87), specificity 0.86 (95% CI 0.82-0.89), positive likelihood ratio 4.94 (95% CI 2.28-10.70), negative likelihood ratio 0.22 (95% CI 0.10-0.52), and diagnostic OR 22.55 (95% CI 7.01-108.30). The area under the curve was 0.92. There was evidence of significant heterogeneity but no evidence of publication bias.Serum PCT is a relatively sensitive and specific test for the identification of SBP. However, due to the limited high-quality studies available, medical decisions should be carefully made in the context of both PCT test results and other clinical findings.
对终末期肝病所致自发性细菌性腹膜炎（SBP）进行早期诊断和及时治疗对于缩短住院时间和降低死亡率至关重要。许多研究探讨了血清降钙素原（PCT）在预测SBP方面的潜在作用。本研究的目的是评估PCT水平对识别终末期肝病所致SBP的总体诊断准确性。在对Medline、Embase和Cochrane数据库进行系统检索，以查找评估PCT对SBP诊断作用的研究后，使用随机效应模型汇总了血清PCT浓度在SBP诊断中的敏感性、特异性和其他准确性指标。采用汇总受试者工作特征曲线来总结总体检验性能。七篇出版物符合纳入标准，涵盖742例疑似SBP病例以及339例确诊病例。血清PCT在诊断终末期肝病所致SBP中的汇总估计值为：敏感性0.82（95%可信区间0.79 - 0.87），特异性0.86（95%可信区间0.82 - 0.89），阳性似然比4.94（95%可信区间2.28 - 10.70），阴性似然比0.22（95%可信区间0.10 - 0.52），诊断比值比22.55（95%可信区间7.01 - 108.30）。曲线下面积为0.92。有显著异质性的证据，但无发表偏倚的证据。血清PCT是一种用于识别SBP的相对敏感和特异的检测方法。然而，由于可用的高质量研究有限，应结合PCT检测结果和其他临床发现谨慎做出医疗决策。
