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Open Access Highly Accessed Research article

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

Shi-kun Yang1, Li Xiao1, Hao Zhang2, Xiao-xuan Xu1, Pan-ai Song1, Fu-you Liu1 and Lin Sun1*

Author Affiliations

1 Department of Nephrology, The Second Xiangya Hospital, Kidney Institute of Central South University, Changsha, Hunan 410011, China

2 Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province 410013, China

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BMC Infectious Diseases 2014, 14:452  doi:10.1186/1471-2334-14-452

Published: 22 August 2014

Abstract

Background

Bacterial 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.

Methods

We 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.

Results

Eighteen 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.

Conclusions

Our 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.

Keywords:
Procalcitonin; Diagnosis; Peritonitis; Meta-analysis