Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha 410011, China.
Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Dis Markers. 2020 Jan 23;2020:4873074. doi: 10.1155/2020/4873074. eCollection 2020.
Gram-negative bloodstream infections (GNBSIs), especially those caused by antibiotic-resistant species, have become a public health challenge. Procalcitonin (PCT) showed promising potential in early diagnosis of GNBSI; however, little was known about its performance under different clinical settings. We here systematically assessed the diagnostic accuracy of PCT in recognizing GNBSI and made direct comparisons with C-reactive protein (CRP) and interleukin 6 (IL-6).
PubMed, Embase, ISI Web of Knowledge, and Scopus were searched from inception to March 15th, 2019. Area under the summary receiver operating characteristic curve (AUC), pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated. Hierarchical summary receiver operating characteristic (HSROC) model was used for the investigation of heterogeneity and for comparisons between markers.
25 studies incorporating 50933 suspected BSI episodes were included. Pooled sensitivity and specificity for PCT were 0.71 and 0.76, respectively. The overall AUC was 0.80. The lowest AUCs were found in patients with febrile neutropenia (0.69) and hematological malignancy (0.69). The highest AUC was found in groups using electrochemiluminescence immunoassay (0.87). In direct comparisons, PCT showed better overall performance than CRP with the AUC being 0.85 (95% CI 0.81-0.87) for PCT and 0.78 (95% CI 0.74-0.81) for CRP, but the relative DORs varied with thresholds between PCT and CRP ( < 0.001). No significant difference was found either in threshold ( < 0.001). No significant difference was found either in threshold ( < 0.001). No significant difference was found either in threshold (.
PCT was helpful in recognizing GNBSI, but the test results should be interpreted carefully with knowledge of patients' medical condition and should not serve as the only criterion for GNBSI. Further prospective studies are warranted for comparisons between different clinical settings.
革兰氏阴性菌血流感染（GNBSI），尤其是由抗生素耐药菌引起的感染，已成为公共卫生领域的一项挑战。降钙素原（PCT）在早期诊断 GNBSI 方面显示出良好的应用前景，但在不同临床环境下的表现仍知之甚少。本研究系统评估了 PCT 识别 GNBSI 的诊断准确性，并与 C 反应蛋白（CRP）和白细胞介素 6（IL-6）进行了直接比较。
检索了 PubMed、Embase、ISI Web of Knowledge 和 Scopus 自成立至 2019 年 3 月 15 日的数据。计算汇总受试者工作特征曲线下面积（AUC）、合并敏感度、特异度和诊断比值比（DOR）。采用分层汇总受试者工作特征（HSROC）模型进行异质性分析，并比较各标志物之间的差异。
纳入了 25 项研究，共计 50933 例疑似菌血症患者。PCT 的合并敏感度和特异度分别为 0.71 和 0.76，AUC 为 0.80。在中性粒细胞减少性发热（0.69）和血液恶性肿瘤（0.69）患者中 AUC 最低，电化学发光免疫分析法（0.87）组的 AUC 最高。在直接比较中，PCT 的总体性能优于 CRP，AUC 分别为 0.85（95%CI 0.81-0.87）和 0.78（95%CI 0.74-0.81），但 PCT 和 CRP 的阈值间的相对 DOR 不同（<0.001）。
PCT 有助于识别 GNBSI，但应结合患者的病情，谨慎解读检测结果，不应将其作为 GNBSI 的唯一诊断标准。还需要进一步的前瞻性研究来比较不同临床环境下的结果。
