Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis

Abstract

Procalcitonin (PCT) has been widely investigated for its prognostic value in septic patients. However, studies have produced conflicting results. The purpose of the present meta-analysis is to explore the diagnostic accuracy of a single PCT concentration and PCT non-clearance in predicting all-cause sepsis mortality. We searched PubMed, Embase, Web of Knowledge and the Cochrane Library. Articles written in English were included. A 2 × 2 contingency table was constructed based on all-cause mortality and PCT level or PCT non-clearance in septic patients. Two authors independently evaluated study eligibility and extracted data. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. We used the Q-test and I 2 index to test heterogeneity. Twenty-three studies with 3,994 patients were included. An elevated PCT level was associated with a higher risk of death. The pooled relative risk (RR) was 2.60 (95% confidence interval (CI), 2.05–3.30) using a random-effects model (I 2 = 63.5%). The overall area under the summary receiver operator characteristic (SROC) curve was 0.77 (95% CI, 0.73–0.80), with a sensitivity and specificity of 0.76 (95% CI, 0.67–0.82) and 0.64 (95% CI, 0.52–0.74), respectively. There was significant evidence of heterogeneity for the PCT testing time (P = 0.020). Initial PCT values were of limited prognostic value in patients with sepsis. PCT non-clearance was a prognostic factor of death in patients with sepsis. The pooled RR was 3.05 (95% CI, 2.35–3.95) using a fixed-effects model (I 2 = 37.9%). The overall area under the SROC curve was 0.79 (95% CI, 0.75–0.83), with a sensitivity and specificity of 0.72 (95% CI, 0.58–0.82) and 0.77 (95% CI, 0.55–0.90), respectively. Elevated PCT concentrations and PCT non-clearance are strongly associated with all-cause mortality in septic patients. Further studies are needed to define the optimal cut-off point and the optimal definition of PCT non-clearance for accurate risk assessment.

Plasma Monocyte Chemoattractant Protein 1 as a Predictive Marker for Sepsis Prognosis: A Prospective Cohort Study

“…The sensitivity and specificity values of PCT (62.5% and 67.7%, respectively) were lower than those of MCP-1 (76.8% and 71.3%, respectively). PCT, which is a sensitive systemic marker of inflammation, especially bacterial infection, has been shown to be useful for predicting mortality in patients with sepsis (Liu et al 2015). Our result revealed a significant association between the expression levels of MCP-1 and PCT.…”

Diagnostic and prognostic performances of serum procalcitonin in patients with bloodstream infections: A parallel, case-control study comprising adults and elderly

“…12 This may also affect the prognostic value of PCT in patients with BSIs. 15 As to address this limitation, we have performed this study to examine diagnostic and prognostic values of serum PCT in the management of adult and elderly patients with BSIs, separately.…”

Bacterial sepsis

“…Interpretation of the PCT value in critically ill patients with relevant liver diseases or after liver surgery is sometimes equally difficult: a PCT increase may be measured in these patients in the absence of a bacterial infection. Whether PCT can be considered a sufficiently reliable marker for differentiating between different grades of sepsis severity and noninfectious SIRS is controversially discussed [58,60,61]. The specificity and sensitivity of PCT for sepsis diagnosis are under 90%, irrespective of the cutoff value used by the measuring laboratory [62,63].…”