Procalcitonin for predicting catheter-associated bloodstream infection

Abstract

Objective: The predictive accuracies of procalcitonin (PCT) in the diagnosis of catheter-associated bloodstream infection (CABSI) vary widely. This meta-analysis aimed to explore the predictive value of PCT for CABSI.Methods: We searched PubMed, EMBase, Web of Science, ScienceDirect, Cochrane Library, and studies published up to 10 March 2019. Odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated to evaluate PCT predictive value using Stata 14.0 software. Results:The meta-analysis was composed of 7 studies, consisting of 347 subjects. Pooled analysis demonstrated that a high PCT was significantly correlated with CABSI (pooled OR = 23.36, 95%CI 12.43-43.91, P < .001) and medium heterogenicity (I 2 = 36.9%, P = .147). The pooled sensitivity and specificity were 85% (95%CI 0.76-0.91) and 89% (95%CI 0.68-0.97), respectively. Although Begg funnel plot (P = .007) indicated the presence of publication bias among the included studies, the stability of the pooled outcomes was verified by the trim-and-fill method. Furthermore, sensitivity analyses did not show important differences in effect estimation. Conclusion:PCT is an effective predictor of CABSI. However, high-quality randomized controlled trials are needed to determine whether PCT could predict CABSI.Abbreviations: AUC = area under the curve, CABSI = catheter-associated bloodstream infection, CI = confidence interval, CVCs = Central venous Catheters, OR = odds ratio, PCT = procalcitonin, PQ = paraquat, QUADAS-2 = Quality Assessment of Diagnostic Accuracy Studies 2 tool.

Use of infection biomarkers in the emergency department

“…[ 14 ] Similarly, negative PCT levels (<0.5 ng/mL) were found to exclude catheter-related bloodstream infection with an error probability of 11%. [ 15 ] However, PCT levels may change depending on the source of infection and infectious agents, limiting the use of PCT to exclude bacterial infections. [ 16 ]…”