降钙素原可否用于诊断革兰氏阴性菌血流感染？基于荟萃分析的证据。

Can procalcitonin be used to diagnose Gram-negative bloodstream infection? Evidence based on a meta-analysis.

机构信息

Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.

出版信息

Eur Rev Med Pharmacol Sci. 2017 Jul;21(14):3253-3261.

Abstract

OBJECTIVE

Procalcitonin (PCT) is a useful biomarker for systemic bacterial infection, and many studies have described the correlation between high serum PCT level and Gram-negative bloodstream infection (BSI), whereas the diagnostic accuracy of PCT for this kind of episode has not been summarized. This study aimed to estimate the overall accuracy of serum PCT for diagnosing Gram-negative BSI through a meta-analysis.

MATERIALS AND METHODS

We searched PubMed, EMBASE, Web of Science, and Scopus database for studies that met the inclusion criteria. The pooled sensitivity, specificity, positive/negative likelihood ratio (PLR/NLR), and diagnostic odds ratio (DOR) were calculated using bivariate random-effects models. Summary receiver operating characteristic (SROC) curve and area under the curve (AUC) were used to summarize overall diagnostic accuracy.

RESULTS

Our meta-analysis included 13 studies involving 4,513 subjects. Summary estimates for PCT in diagnosing Gram-negative BSI were as follows: sensitivity, 0.73 (95% CI 0.68 to 0.78); specificity, 0.74 (95% CI 0.64 to 0.81); PLR, 2.77 (95% CI 2.07 to 3.70); NLR, 0.37 (95% CI 0.31 to 0.42); DOR, 7.59 (95% CI 5.31 to 10.85); AUC, 0.79 (95% CI 0.75 to 0.82). The corresponding summary performance estimates for using PCT in differentiating Gram-negative BSI from gram-positive BSI were as follows: sensitivity, 0.73 (95% CI 0.66 to 0.78); specificity, 0.70 (95% CI 0.59 to 0.78); PLR, 2.40 (95% CI, 1.83 to 3.15); NLR, 0.39 (95% CI 0.33 to 0.46); DOR, 6.15 (95% CI 4.40 to 8.60); AUC, 0.77 (95% CI 0.73 to 0.81).

CONCLUSIONS

PCT may have a limited diagnostic value for Gram-negative BSI.

摘要

目的

降钙素原（PCT）是一种用于全身细菌感染的有用生物标志物，许多研究已经描述了血清 PCT 水平升高与革兰氏阴性菌血流感染（BSI）之间的相关性，然而，PCT 对此类感染的诊断准确性尚未得到总结。本研究旨在通过荟萃分析来评估血清 PCT 诊断革兰氏阴性菌 BSI 的总体准确性。

材料与方法

我们在 PubMed、EMBASE、Web of Science 和 Scopus 数据库中搜索符合纳入标准的研究。使用双变量随机效应模型计算汇总敏感性、特异性、阳性/阴性似然比（PLR/NLR）和诊断比值比（DOR）。采用综合受试者工作特征（SROC）曲线和曲线下面积（AUC）来总结整体诊断准确性。

结果

我们的荟萃分析纳入了 13 项涉及 4513 名受试者的研究。PCT 诊断革兰氏阴性菌 BSI 的汇总估计值如下：敏感性，0.73（95%置信区间 0.68 至 0.78）；特异性，0.74（95%置信区间 0.64 至 0.81）；PLR，2.77（95%置信区间 2.07 至 3.70）； NLR，0.37（95%置信区间 0.31 至 0.42）；DOR，7.59（95%置信区间 5.31 至 10.85）；AUC，0.79（95%置信区间 0.75 至 0.82）。使用 PCT 区分革兰氏阴性菌和革兰氏阳性菌 BSI 的汇总性能估计值如下：敏感性，0.73（95%置信区间 0.66 至 0.78）；特异性，0.70（95%置信区间 0.59 至 0.78）；PLR，2.40（95%置信区间，1.83 至 3.15）； NLR，0.39（95%置信区间 0.33 至 0.46）；DOR，6.15（95%置信区间 4.40 至 8.60）；AUC，0.77（95%置信区间 0.73 至 0.81）。