Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis

Summary Procalcitonin is widely reported as a useful biochemical marker to differentiate sepsis from other non-infectious causes of systemic inflammatory response syndrome. In this systematic review, we estimated the diagnostic accuracy of procalcitonin in sepsis diagnosis in critically ill patients...

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Bibliographic Details
Published in:The Lancet infectious diseases 2007-03, Vol.7 (3), p.210-217
Main Authors: Tang, Benjamin MP, Dr, Eslick, Guy D, PhD, Craig, Jonathan C, MD, McLean, Anthony S, MD
Format: Article
Language:English
Subjects:
Bacterial diseases
Bacterial sepsis
Biological and medical sciences
Biomarkers - blood
Calcitonin - blood
Calcitonin Gene-Related Peptide
Critical Illness
Diagnosis, Differential
Emergency Medical Services - methods
Heterogeneity
Human bacterial diseases
Humans
Infectious Disease
Infectious diseases
Medical sciences
Predictive Value of Tests
Protein Precursors - blood
Sensitivity and Specificity
Sepsis - diagnosis
Systemic Inflammatory Response Syndrome - diagnosis
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Summary:Summary Procalcitonin is widely reported as a useful biochemical marker to differentiate sepsis from other non-infectious causes of systemic inflammatory response syndrome. In this systematic review, we estimated the diagnostic accuracy of procalcitonin in sepsis diagnosis in critically ill patients. 18 studies were included in the review. Overall, the diagnostic performance of procalcitonin was low, with mean values of both sensitivity and specificity being 71% (95% CI 67–76) and an area under the summary receiver operator characteristic curve of 0·78 (95% CI 0·73–0·83). Studies were grouped into phase 2 studies (n=14) and phase 3 studies (n=4) by use of Sackett and Haynes' classification. Phase 2 studies had a low pooled diagnostic odds ratio of 7·79 (95% CI 5·86–10·35). Phase 3 studies showed significant heterogeneity because of variability in sample size (meta-regression coefficient −0·592, p=0·017), with diagnostic performance upwardly biased in smaller studies, but moving towards a null effect in larger studies. Procalcitonin cannot reliably differentiate sepsis from other non-infectious causes of systemic inflammatory response syndrome in critically ill adult patients. The findings from this study do not lend support to the widespread use of the procalcitonin test in critical care settings.
ISSN:1473-3099
1474-4457
DOI:10.1016/S1473-3099(07)70052-X