Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study.

Publisher: Hindawi Pub. Corp Country of Publication: United States NLM ID: 8604127 Publication Model: eCollection Cited Medium: Internet ISSN: 1875-8630 (Electronic) Linking ISSN: 02780240 NLM ISO Abbreviation: Dis Markers Subsets: MEDLINE

Publication: 2015- : New York, NY : Hindawi Pub. Corp.
Original Publication: Chichester ; New York : Wiley, c1983-

Bacteremia/*diagnosis ; Biomarkers/*analysis ; Gram-Negative Bacterial Infections/*diagnosis; Bacteremia/metabolism ; C-Reactive Protein/analysis ; Deep Learning ; Early Diagnosis ; Gram-Negative Bacterial Infections/metabolism ; Humans ; Interleukin-6/analysis ; Procalcitonin/analysis ; Sensitivity and Specificity

Objective: 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).
Methods: 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.
Results: 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 ( p < 0.001). No significant difference was found either in threshold ( p < 0.001). No significant difference was found either in threshold ( p < 0.001). No significant difference was found either in threshold (.
Conclusions: 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.
Competing Interests: The authors have declared that no conflicts of interest exist.
(Copyright © 2020 Liying Lai et al.)

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0 (Biomarkers)
0 (IL6 protein, human)
0 (Interleukin-6)
0 (Procalcitonin)
9007-41-4 (C-Reactive Protein)

Date Created: 20200221 Date Completed: 20201007 Latest Revision: 20220412

20240628

PMC7008263

10.1155/2020/4873074

32076461