Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study
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 clinic...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Hindawi Limited
2020-01-01
|
Series: | Disease Markers |
Online Access: | http://dx.doi.org/10.1155/2020/4873074 |
id |
doaj-83f6869e4ac94b26a80813abc1ad60b7 |
---|---|
record_format |
Article |
spelling |
doaj-83f6869e4ac94b26a80813abc1ad60b72020-11-25T02:04:52ZengHindawi LimitedDisease Markers0278-02401875-86302020-01-01202010.1155/2020/48730744873074Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic StudyLiying Lai0Yijie Lai1Hao Wang2Liang Peng3Ning Zhou4Yi Tian5Yongfang Jiang6Guozhong Gong7Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha 410011, ChinaDepartment of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, ChinaDepartment of Pharmacology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, ChinaDepartment of Infectious Diseases, 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, ChinaDepartment of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha 410011, ChinaDepartment of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha 410011, ChinaDepartment of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha 410011, ChinaDepartment of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha 410011, ChinaObjective. 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=0.654) or in accuracy (p=0.480) between PCT and IL-6 in diagnosing GNBSI. 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.http://dx.doi.org/10.1155/2020/4873074 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Liying Lai Yijie Lai Hao Wang Liang Peng Ning Zhou Yi Tian Yongfang Jiang Guozhong Gong |
spellingShingle |
Liying Lai Yijie Lai Hao Wang Liang Peng Ning Zhou Yi Tian Yongfang Jiang Guozhong Gong Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study Disease Markers |
author_facet |
Liying Lai Yijie Lai Hao Wang Liang Peng Ning Zhou Yi Tian Yongfang Jiang Guozhong Gong |
author_sort |
Liying Lai |
title |
Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study |
title_short |
Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study |
title_full |
Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study |
title_fullStr |
Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study |
title_full_unstemmed |
Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study |
title_sort |
diagnostic accuracy of procalcitonin compared to c-reactive protein and interleukin 6 in recognizing gram-negative bloodstream infection: a meta-analytic study |
publisher |
Hindawi Limited |
series |
Disease Markers |
issn |
0278-0240 1875-8630 |
publishDate |
2020-01-01 |
description |
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=0.654) or in accuracy (p=0.480) between PCT and IL-6 in diagnosing GNBSI. 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. |
url |
http://dx.doi.org/10.1155/2020/4873074 |
work_keys_str_mv |
AT liyinglai diagnosticaccuracyofprocalcitonincomparedtocreactiveproteinandinterleukin6inrecognizinggramnegativebloodstreaminfectionametaanalyticstudy AT yijielai diagnosticaccuracyofprocalcitonincomparedtocreactiveproteinandinterleukin6inrecognizinggramnegativebloodstreaminfectionametaanalyticstudy AT haowang diagnosticaccuracyofprocalcitonincomparedtocreactiveproteinandinterleukin6inrecognizinggramnegativebloodstreaminfectionametaanalyticstudy AT liangpeng diagnosticaccuracyofprocalcitonincomparedtocreactiveproteinandinterleukin6inrecognizinggramnegativebloodstreaminfectionametaanalyticstudy AT ningzhou diagnosticaccuracyofprocalcitonincomparedtocreactiveproteinandinterleukin6inrecognizinggramnegativebloodstreaminfectionametaanalyticstudy AT yitian diagnosticaccuracyofprocalcitonincomparedtocreactiveproteinandinterleukin6inrecognizinggramnegativebloodstreaminfectionametaanalyticstudy AT yongfangjiang diagnosticaccuracyofprocalcitonincomparedtocreactiveproteinandinterleukin6inrecognizinggramnegativebloodstreaminfectionametaanalyticstudy AT guozhonggong diagnosticaccuracyofprocalcitonincomparedtocreactiveproteinandinterleukin6inrecognizinggramnegativebloodstreaminfectionametaanalyticstudy |
_version_ |
1715578666433380352 |