Significance of serum procalcitonin as biomarker for detection of bacterial peritonitis: a systematic review and meta-analysis

Abstract

BackgroundBacterial peritonitis is serious disease and remains a diagnostic challenge for clinicians. Many studies have highlighted the potential usefulness of procalcitonin (PCT) for identification of bacterial peritonitis, however, the overall diagnostic value of PCT remains unclear. Therefore, we performed a meta-analysis to assess the accuracy of PCT for detection of bacterial peritonitis.MethodsWe performed a systematic searched in MEDLINE, EMBASE, SCOPUS, China Biology Medicine Database (CBM), China National Knowledge Infrastructure Database (CNKI) and Cochrane databases for trials that evaluated the diagnostic role of PCT for bacterial peritonitis. Sensitivity, specificity and other measures of accuracy of PCT were pooled using bivariate random effects models.ResultsEighteen studies involving 1827 patients were included in the present meta-analysis. The pooled sensitivity and specificity of serum PCT for the diagnosis bacterial peritonitis were 0.83 (95% CI: 0.76–0.89) and 0.92 (95% CI: 0.87–0.96), respectively. The positive likelihood ratio was 11.06 (95% CI: 6.31–19.38), negative likelihood ratio was 0.18 (95% CI: 0.12–0.27) and diagnostic odds ratio (DOR) was 61.52 (95% CI: 27.58–137.21). The area under the receiver operating characteristic curve (AUROC) was 0.94. Use of a common PCT cut-off value could improve the DOR to 75.32 and the AUROC to 0.95. Analysis of the seven studies that measured serum C-reactive protein (CRP) indicated that PCT was more accurate than CRP for the diagnosis of bacterial peritonitis.ConclusionsOur results indicate that PCT determination is a relatively sensitive and specific test for the diagnosis of bacterial peritonitis. However, with regard to methodological limitations and significant heterogeneity, medical decisions should be based on both clinical findings and PCT test results.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-452) contains supplementary material, which is available to authorized users.

Procalcitonin Reveals Early Dehiscence in Colorectal Surgery

“…5 Recently, biomarkers such as CRP and IL-6 (interleukin 6) have been considered as an interesting tool to early diagnose postoperative complications in other surgical fields. [14][15][16] CRP seems to be a good predictor of septic complications after elective colorectal surgery, as shown in a recent prospective study on 133 patients from Ortega-Deballon et al 17 With a cutoff of 125 mg/L in 4th POD, they obtained a sensitivity of 81.8% and a NPV of 95.8%. 17 Moreover, Scepanovic published similar results on 156 patients, getting the best sensitivity and specificity in 3rd POD (73% and 73%, respectively) with a CRP cutoff of 135 mg/L.…”

“…8 On the contrary, both in our previous 10 and in the present study we showed that renal function did not impair PCT measurement and our results were consistent with Yang study. 15 In our population mean preoperative values of azotemia and creatinine were within the reference range, being respectively 17 and 0.9 mg/ dL. Six patients (1.2%) were affected by chronic renal failure (mean azotemia and creatinine being respectively 40 and 2.8 mg/dL), but we did not register statistically significant differences in the PCT values and incidence of AL between the chronic renal failure group and the patients with normal values of kidneys function.…”

“…21 After analyzing the 18 studies published on the field, the authors conclude that PCT is a sensitive and specific test for diagnosis of bacterial peritonitis, with a better predictive capacity than CRP. 15 Lagoutte et al published the first study comparing PCT and CRP after colorectal surgery. 21 They measured both biomarkers from 1st to 4th POD and concluded that best accuracy for AL diagnosis was given from CRP in 4th POD (AUC 0.869 vs 0.750 for PCT).…”

Human beta‐defensin‐1 is a highly predictive marker of mortality in patients with acute‐on‐chronic liver failure

“…Investigators have used CRP and PCT biomarkers mainly to discriminate infection from non‐infection status in cirrhosis . A recent meta‐analysis aiming at evaluating the diagnostic performance of PCT and CRP in ACLF patient found that PCT was a good diagnostic tool to rule‐in and CRP to rule‐out an infection …”

“…Regarding CRP and PCT, the former is mainly synthesized in the liver as a response to Interleukin-6 (IL-6) while the latter is produced by nearly all tissues in response to Τumor Νecrosis Factor-a (TNF-a) and other inflammatory cytokines. 28 Investigators have used CRP and PCT biomarkers mainly to discriminate infection from non-infection status in cirrhosis. 29 A recent meta-analysis aiming at evaluating the diagnostic performance of PCT and CRP in ACLF patient found that PCT was a good diagnostic tool to rule-in and CRP to rule-out an infection.…”