Diagnostic Accuracy of Serum Procalcitonin for Spontaneous Bacterial Peritonitis Due to End-stage Liver Disease

Abstract

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.

Diagnostic Value of Serum Procalcitonin Level in HCV Cirrhotic Patients with Spontaneous Bacterial Peritonitis

“…As regard PCT results show that: Patients in group 1 whish have spontaneous bacterial peritonitis, 95% of them have serum procalcitonin positive and 5% were negative, Patients and participants in groups 2,3,4 wish have sterile ascites or not ascetic or not cirrhotic respectively have serum procalcitonin negative in 95% PCT Negative Results Positive of them and positive in 5%. Our results were in agreement with Yang, et al 10 , who found that; Serum PCT is a relatively sensitive (95%) and specific (95%) 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.…”

“…It is therefore clear that using blood for routine examinations is more convenient and safer than ascitic fluid, and the measurement of serum biomarkers has consequently received much attention recently for the early diagnosis of SBP. 10 Procalcitonin (PCT) is a precursor of calcitonin, normally secreted by C cells of the thyroid in healthy individuals. In the absence of infection, the extrathyroidal expression of the PCT gene in the liver, lung, kidney, adrenal tissue, monocytes, granulocytes, testis, prostate gland, and small intestine is suppressed.…”

A novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infections

“…Procalcitonin (PCT) is a 116-amino acid polypeptide precursor of calcitonin with a molecular weight of 13 KDa produced by extra-thyroidal cells (e.g., monocytes) [24]. It has been proposed in highly cited studies as a potentially valuable serum biomarker to diagnose bacterial infections in general [24][25][26] and SBP in particular [27][28][29][30]. Normally, serum PCT level is undetectable (< 0.01 ng/mL), and it rapidly increases in case of infection [26].…”

Update Review Article: Spontaneous Bacterial Peritonitis

“…Serum procalcitonin was significantly higher in SBP than in sterile ascites in six of the seven which supports use of serum procalcitonin as an SBP marker. In a review by Yang et al 47 of the available data from 339 patients with LC accompanied by SBP, it was concluded that serum procalcitonin was a relatively sensitive and specific marker for the diagnosis of SBP. It has been reported that serum procalcitonin was significantly higher in cirrhotic patients with culture-positive SBP than in those with CNNA.…”