Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: A systematic review and meta-analysis

Chia Hung Yo, Pei Shan Hsieh, Si Huei Lee, Jiunn Yih Wu, Shy Shin Chang, Kuang Chau Tasi, Chien Chang Lee

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Study objective: We determine the usefulness of the procalcitonin for early identification of young children at risk for severe bacterial infection among those presenting with fever without source. Methods: The design was a systematic review and meta-analysis of diagnostic studies. Data sources were searches of MEDLINE and EMBASE in April 2011. Included were diagnostic studies that evaluated the diagnostic value of procalcitonin alone or compared with other laboratory markers, such as C-reactive protein or leukocyte count, to detect severe bacterial infection in children with fever without source who were aged between 7 days and 36 months. Results: Eight studies were included (1,883 patients) for procalcitonin analysis, 6 (1,265 patients) for C-reactive protein analysis, and 7 (1,649 patients) for leukocyte analysis. The markers differed in their ability to predict serious bacterial infection: procalcitonin (odds ratio [OR] 10.6; 95% confidence interval [CI] 6.9 to 16.0), C-reactive protein (OR 9.83; 95% CI 7.05 to 13.7), and leukocytosis (OR 4.26; 95% CI 3.22 to 5.63). The random-effect model was used for procalcitonin analysis because heterogeneity across studies existed. Overall sensitivity was 0.83 (95% CI 0.70 to 0.91) for procalcitonin, 0.74 (95% CI 0.65 to 0.82) for C-reactive protein, and 0.58 (95% CI 0.49 to 0.67) for leukocyte count. Overall specificity was 0.69 (95% CI 0.59 to 0.85) for procalcitonin, 0.76 (95% CI 0.70 to 0.81) for C-reactive protein, and 0.73 (95% CI 0.67 to 0.77) for leukocyte count. Conclusion: Procalcitonin performs better than leukocyte count and C-reactive protein for detecting serious bacterial infection among children with fever without source. Considering the poor pooled positive likelihood ratio and acceptable pooled negative likelihood ratio, procalcitonin is better for ruling out serious bacterial infection than for ruling it in. Existing studies do not define how best to combine procalcitonin with other clinical information.

Original languageEnglish
Pages (from-to)591-600
Number of pages10
JournalAnnals of Emergency Medicine
Volume60
Issue number5
DOIs
Publication statusPublished - Nov 1 2012
Externally publishedYes

Fingerprint

Leukocytosis
Calcitonin
Bacterial Infections
C-Reactive Protein
Meta-Analysis
Fever
Confidence Intervals
Leukocyte Count
Odds Ratio
Information Storage and Retrieval
MEDLINE
Leukocytes
Biomarkers

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source : A systematic review and meta-analysis. / Yo, Chia Hung; Hsieh, Pei Shan; Lee, Si Huei; Wu, Jiunn Yih; Chang, Shy Shin; Tasi, Kuang Chau; Lee, Chien Chang.

In: Annals of Emergency Medicine, Vol. 60, No. 5, 01.11.2012, p. 591-600.

Research output: Contribution to journalArticle

@article{b2eff497acfc4da59328f15313a61e01,
title = "Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: A systematic review and meta-analysis",
abstract = "Study objective: We determine the usefulness of the procalcitonin for early identification of young children at risk for severe bacterial infection among those presenting with fever without source. Methods: The design was a systematic review and meta-analysis of diagnostic studies. Data sources were searches of MEDLINE and EMBASE in April 2011. Included were diagnostic studies that evaluated the diagnostic value of procalcitonin alone or compared with other laboratory markers, such as C-reactive protein or leukocyte count, to detect severe bacterial infection in children with fever without source who were aged between 7 days and 36 months. Results: Eight studies were included (1,883 patients) for procalcitonin analysis, 6 (1,265 patients) for C-reactive protein analysis, and 7 (1,649 patients) for leukocyte analysis. The markers differed in their ability to predict serious bacterial infection: procalcitonin (odds ratio [OR] 10.6; 95{\%} confidence interval [CI] 6.9 to 16.0), C-reactive protein (OR 9.83; 95{\%} CI 7.05 to 13.7), and leukocytosis (OR 4.26; 95{\%} CI 3.22 to 5.63). The random-effect model was used for procalcitonin analysis because heterogeneity across studies existed. Overall sensitivity was 0.83 (95{\%} CI 0.70 to 0.91) for procalcitonin, 0.74 (95{\%} CI 0.65 to 0.82) for C-reactive protein, and 0.58 (95{\%} CI 0.49 to 0.67) for leukocyte count. Overall specificity was 0.69 (95{\%} CI 0.59 to 0.85) for procalcitonin, 0.76 (95{\%} CI 0.70 to 0.81) for C-reactive protein, and 0.73 (95{\%} CI 0.67 to 0.77) for leukocyte count. Conclusion: Procalcitonin performs better than leukocyte count and C-reactive protein for detecting serious bacterial infection among children with fever without source. Considering the poor pooled positive likelihood ratio and acceptable pooled negative likelihood ratio, procalcitonin is better for ruling out serious bacterial infection than for ruling it in. Existing studies do not define how best to combine procalcitonin with other clinical information.",
author = "Yo, {Chia Hung} and Hsieh, {Pei Shan} and Lee, {Si Huei} and Wu, {Jiunn Yih} and Chang, {Shy Shin} and Tasi, {Kuang Chau} and Lee, {Chien Chang}",
year = "2012",
month = "11",
day = "1",
doi = "10.1016/j.annemergmed.2012.05.027",
language = "English",
volume = "60",
pages = "591--600",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source

T2 - A systematic review and meta-analysis

AU - Yo, Chia Hung

AU - Hsieh, Pei Shan

AU - Lee, Si Huei

AU - Wu, Jiunn Yih

AU - Chang, Shy Shin

AU - Tasi, Kuang Chau

AU - Lee, Chien Chang

PY - 2012/11/1

Y1 - 2012/11/1

N2 - Study objective: We determine the usefulness of the procalcitonin for early identification of young children at risk for severe bacterial infection among those presenting with fever without source. Methods: The design was a systematic review and meta-analysis of diagnostic studies. Data sources were searches of MEDLINE and EMBASE in April 2011. Included were diagnostic studies that evaluated the diagnostic value of procalcitonin alone or compared with other laboratory markers, such as C-reactive protein or leukocyte count, to detect severe bacterial infection in children with fever without source who were aged between 7 days and 36 months. Results: Eight studies were included (1,883 patients) for procalcitonin analysis, 6 (1,265 patients) for C-reactive protein analysis, and 7 (1,649 patients) for leukocyte analysis. The markers differed in their ability to predict serious bacterial infection: procalcitonin (odds ratio [OR] 10.6; 95% confidence interval [CI] 6.9 to 16.0), C-reactive protein (OR 9.83; 95% CI 7.05 to 13.7), and leukocytosis (OR 4.26; 95% CI 3.22 to 5.63). The random-effect model was used for procalcitonin analysis because heterogeneity across studies existed. Overall sensitivity was 0.83 (95% CI 0.70 to 0.91) for procalcitonin, 0.74 (95% CI 0.65 to 0.82) for C-reactive protein, and 0.58 (95% CI 0.49 to 0.67) for leukocyte count. Overall specificity was 0.69 (95% CI 0.59 to 0.85) for procalcitonin, 0.76 (95% CI 0.70 to 0.81) for C-reactive protein, and 0.73 (95% CI 0.67 to 0.77) for leukocyte count. Conclusion: Procalcitonin performs better than leukocyte count and C-reactive protein for detecting serious bacterial infection among children with fever without source. Considering the poor pooled positive likelihood ratio and acceptable pooled negative likelihood ratio, procalcitonin is better for ruling out serious bacterial infection than for ruling it in. Existing studies do not define how best to combine procalcitonin with other clinical information.

AB - Study objective: We determine the usefulness of the procalcitonin for early identification of young children at risk for severe bacterial infection among those presenting with fever without source. Methods: The design was a systematic review and meta-analysis of diagnostic studies. Data sources were searches of MEDLINE and EMBASE in April 2011. Included were diagnostic studies that evaluated the diagnostic value of procalcitonin alone or compared with other laboratory markers, such as C-reactive protein or leukocyte count, to detect severe bacterial infection in children with fever without source who were aged between 7 days and 36 months. Results: Eight studies were included (1,883 patients) for procalcitonin analysis, 6 (1,265 patients) for C-reactive protein analysis, and 7 (1,649 patients) for leukocyte analysis. The markers differed in their ability to predict serious bacterial infection: procalcitonin (odds ratio [OR] 10.6; 95% confidence interval [CI] 6.9 to 16.0), C-reactive protein (OR 9.83; 95% CI 7.05 to 13.7), and leukocytosis (OR 4.26; 95% CI 3.22 to 5.63). The random-effect model was used for procalcitonin analysis because heterogeneity across studies existed. Overall sensitivity was 0.83 (95% CI 0.70 to 0.91) for procalcitonin, 0.74 (95% CI 0.65 to 0.82) for C-reactive protein, and 0.58 (95% CI 0.49 to 0.67) for leukocyte count. Overall specificity was 0.69 (95% CI 0.59 to 0.85) for procalcitonin, 0.76 (95% CI 0.70 to 0.81) for C-reactive protein, and 0.73 (95% CI 0.67 to 0.77) for leukocyte count. Conclusion: Procalcitonin performs better than leukocyte count and C-reactive protein for detecting serious bacterial infection among children with fever without source. Considering the poor pooled positive likelihood ratio and acceptable pooled negative likelihood ratio, procalcitonin is better for ruling out serious bacterial infection than for ruling it in. Existing studies do not define how best to combine procalcitonin with other clinical information.

UR - http://www.scopus.com/inward/record.url?scp=84868200818&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84868200818&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2012.05.027

DO - 10.1016/j.annemergmed.2012.05.027

M3 - Article

C2 - 22921165

AN - SCOPUS:84868200818

VL - 60

SP - 591

EP - 600

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 5

ER -