He Xinchun, Chen Liang, Chen Haiou, Feng Yuqing, Zhu Baining, Yang Caixia
Department of Infectious Disease, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan 410005, China.
Bioinorg Chem Appl. 2021 Jul 5;2021:5801139. doi: 10.1155/2021/5801139. eCollection 2021.
The purpose of our studies was to systematically assess the accuracy and clinical value of plasma calcitonin in patients with liver failure complicated with bacterial infection. In this study, we included prospective observational studies or randomized controlled trials on PCT. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Heterogeneity, pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, the area under the summary receiver operating characteristic curve (SROC), and metaregression analysis were performed using Stata16.0 software. Consequently, the studies revealed substantial heterogeneity ( = 96, 95% confidence interval (95% CI) = 94-99). The results of meta-analysis using random effect models suggested that the combined DOR was 10.67 (95% CI = 3.73-30.53). In addition, the threshold effect analysis showed that the threshold effect was 0.23 and the correlation coefficient was -0.48, indicating that there was no threshold effect. In the forest map, the DOR of each study and the combined DOR are not distributed along the same line, and = 2.2 × 10, ≤ 0.001. Furthermore, the metaregression analysis of PCT study design, bacterial infection site, and mean age displayed that the values were >0.05. The combined sensitivity was 0.77 (95% CI = 0.54-0.90), the combined specificity was 0.76 (95% CI = 0.70-0.82), the combined positive likelihood ratio was 3.25 (95% CI = 2.33-4.52), the combined negative likelihood ratio was 0.30 (95% CI = 0.14-0.67), and the combined AUC was 0.80 (95% CI = 0.76-0.83). In conclusion, PCT has moderate diagnostic value for adult liver failure complicated with bacterial infection, and it is a better auxiliary diagnostic index for liver failure with bacterial infection. However, the results of procalcitonin must be carefully interpreted combined with medical history, physical examination, and microbiological assessment.
我们研究的目的是系统评估降钙素原（PCT）在肝功能衰竭合并细菌感染患者中的准确性及临床价值。在本研究中，我们纳入了关于PCT的前瞻性观察性研究或随机对照试验。采用诊断准确性研究质量评估-2（QUADAS-2）工具对研究质量进行评估。使用Stata16.0软件进行异质性分析、合并诊断比值比（DOR）、合并敏感度、合并特异度、合并阳性似然比、合并阴性似然比、汇总受试者工作特征曲线（SROC）下面积以及Meta回归分析。结果显示，研究存在显著异质性（I² = 96，95%置信区间（95%CI）= 94 - 99）。采用随机效应模型的Meta分析结果表明，合并DOR为10.67（95%CI = 3.73 - 30.53）。此外，阈值效应分析显示阈值效应为0.23，相关系数为 - 0.48，表明不存在阈值效应。在森林图中，各研究的DOR及合并DOR并非沿同一条线分布，I² = 2.2×10，P≤0.001。此外，对PCT研究设计、细菌感染部位及平均年龄的Meta回归分析显示P值均>0.05。合并敏感度为0.77（95%CI = 0.54 - 0.90），合并特异度为0.76（95%CI = 0.70 - 0.82），合并阳性似然比为3.25（95%CI = 2.33 - 4.52），合并阴性似然比为0.30（95%CI = 0.14 - 0.67），合并AUC为0.80（95%CI = 0.76 - 0.83）。总之，PCT对成人肝功能衰竭合并细菌感染具有中等诊断价值，是细菌感染所致肝功能衰竭较好的辅助诊断指标。然而，降钙素原的结果必须结合病史、体格检查及微生物学评估进行谨慎解读。
