Use of serum procalcitonin to detect bacterial infection in patients with autoimmune diseases: A systematic review and meta-analysis

Jiunn Yih Wu, Si Huei Lee, Chih Jung Shen, Yueh Che Hsieh, Ping Hsiung Yo, Hsiang Yun Cheng, Rai Chi Chan, Chien Chang Lee, Shy Shin Chang

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Objective To systematically review evidence of the accuracy of the procalcitonin test for diagnosis of bacterial infection in patients with autoimmune disease. Methods The major databases Medline, EMBase, and the Cochrane Library were searched for studies published between January 1966 and October 2011 that evaluated procalcitonin, alone or in comparison with other laboratory markers such as C-reactive protein (CRP), as a diagnostic marker for bacterial infection in patients with autoimmune disease and provided sufficient data to permit construction of 2 × 2 tables. Results Nine studies were included in the final meta-analysis. The area under the summary receiver operating characteristic curve values were 0.91 (95% confidence interval [95% CI] 0.88-0.93) for procalcitonin and 0.81 (95% CI 0.78-0.84) for CRP. In general, testing for procalcitonin was highly specific for identifying infectious complications, although it was not as sensitive as testing for CRP. Pooled sensitivity was 0.75 (95% CI 0.63-0.84) for procalcitonin tests and 0.77 (95% CI 0.67-0.85) for CRP tests. Pooled specificity was 0.90 (95% CI 0.85-0.93) for procalcitonin tests and 0.56 (95% CI 0.25-0.83) for CRP tests. The positive likelihood ratio for procalcitonin (7.28 [95% CI 5.10-10.38]) was sufficiently high to qualify procalcitonin testing as a rule-in diagnostic tool, while the negative likelihood ratio (0.28 [95% CI 0.18-0.40]) was not sufficiently low to qualify procalcitonin testing as a reliable rule-out diagnostic tool. Conclusion Procalcitonin has higher diagnostic value than CRP for the detection of bacterial sepsis in patients with autoimmune disease, and the test for procalcitonin is more specific than sensitive. A procalcitonin test is not recommended to be used in isolation as a rule-out tool.

Original languageEnglish
Pages (from-to)3034-3042
Number of pages9
JournalArthritis and Rheumatism
Volume64
Issue number9
DOIs
Publication statusPublished - Sep 1 2012
Externally publishedYes

Fingerprint

Calcitonin
Bacterial Infections
Autoimmune Diseases
Meta-Analysis
Serum
C-Reactive Protein
Confidence Intervals
ROC Curve
Libraries
Sepsis
Biomarkers
Databases

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Pharmacology (medical)

Cite this

Use of serum procalcitonin to detect bacterial infection in patients with autoimmune diseases : A systematic review and meta-analysis. / Wu, Jiunn Yih; Lee, Si Huei; Shen, Chih Jung; Hsieh, Yueh Che; Yo, Ping Hsiung; Cheng, Hsiang Yun; Chan, Rai Chi; Lee, Chien Chang; Chang, Shy Shin.

In: Arthritis and Rheumatism, Vol. 64, No. 9, 01.09.2012, p. 3034-3042.

Research output: Contribution to journalArticle

Wu, Jiunn Yih ; Lee, Si Huei ; Shen, Chih Jung ; Hsieh, Yueh Che ; Yo, Ping Hsiung ; Cheng, Hsiang Yun ; Chan, Rai Chi ; Lee, Chien Chang ; Chang, Shy Shin. / Use of serum procalcitonin to detect bacterial infection in patients with autoimmune diseases : A systematic review and meta-analysis. In: Arthritis and Rheumatism. 2012 ; Vol. 64, No. 9. pp. 3034-3042.
@article{cf43fa25f2e949e383b00e2024358611,
title = "Use of serum procalcitonin to detect bacterial infection in patients with autoimmune diseases: A systematic review and meta-analysis",
abstract = "Objective To systematically review evidence of the accuracy of the procalcitonin test for diagnosis of bacterial infection in patients with autoimmune disease. Methods The major databases Medline, EMBase, and the Cochrane Library were searched for studies published between January 1966 and October 2011 that evaluated procalcitonin, alone or in comparison with other laboratory markers such as C-reactive protein (CRP), as a diagnostic marker for bacterial infection in patients with autoimmune disease and provided sufficient data to permit construction of 2 × 2 tables. Results Nine studies were included in the final meta-analysis. The area under the summary receiver operating characteristic curve values were 0.91 (95{\%} confidence interval [95{\%} CI] 0.88-0.93) for procalcitonin and 0.81 (95{\%} CI 0.78-0.84) for CRP. In general, testing for procalcitonin was highly specific for identifying infectious complications, although it was not as sensitive as testing for CRP. Pooled sensitivity was 0.75 (95{\%} CI 0.63-0.84) for procalcitonin tests and 0.77 (95{\%} CI 0.67-0.85) for CRP tests. Pooled specificity was 0.90 (95{\%} CI 0.85-0.93) for procalcitonin tests and 0.56 (95{\%} CI 0.25-0.83) for CRP tests. The positive likelihood ratio for procalcitonin (7.28 [95{\%} CI 5.10-10.38]) was sufficiently high to qualify procalcitonin testing as a rule-in diagnostic tool, while the negative likelihood ratio (0.28 [95{\%} CI 0.18-0.40]) was not sufficiently low to qualify procalcitonin testing as a reliable rule-out diagnostic tool. Conclusion Procalcitonin has higher diagnostic value than CRP for the detection of bacterial sepsis in patients with autoimmune disease, and the test for procalcitonin is more specific than sensitive. A procalcitonin test is not recommended to be used in isolation as a rule-out tool.",
author = "Wu, {Jiunn Yih} and Lee, {Si Huei} and Shen, {Chih Jung} and Hsieh, {Yueh Che} and Yo, {Ping Hsiung} and Cheng, {Hsiang Yun} and Chan, {Rai Chi} and Lee, {Chien Chang} and Chang, {Shy Shin}",
year = "2012",
month = "9",
day = "1",
doi = "10.1002/art.34512",
language = "English",
volume = "64",
pages = "3034--3042",
journal = "Arthritis and Rheumatology",
issn = "2326-5191",
publisher = "John Wiley and Sons Ltd",
number = "9",

}

TY - JOUR

T1 - Use of serum procalcitonin to detect bacterial infection in patients with autoimmune diseases

T2 - A systematic review and meta-analysis

AU - Wu, Jiunn Yih

AU - Lee, Si Huei

AU - Shen, Chih Jung

AU - Hsieh, Yueh Che

AU - Yo, Ping Hsiung

AU - Cheng, Hsiang Yun

AU - Chan, Rai Chi

AU - Lee, Chien Chang

AU - Chang, Shy Shin

PY - 2012/9/1

Y1 - 2012/9/1

N2 - Objective To systematically review evidence of the accuracy of the procalcitonin test for diagnosis of bacterial infection in patients with autoimmune disease. Methods The major databases Medline, EMBase, and the Cochrane Library were searched for studies published between January 1966 and October 2011 that evaluated procalcitonin, alone or in comparison with other laboratory markers such as C-reactive protein (CRP), as a diagnostic marker for bacterial infection in patients with autoimmune disease and provided sufficient data to permit construction of 2 × 2 tables. Results Nine studies were included in the final meta-analysis. The area under the summary receiver operating characteristic curve values were 0.91 (95% confidence interval [95% CI] 0.88-0.93) for procalcitonin and 0.81 (95% CI 0.78-0.84) for CRP. In general, testing for procalcitonin was highly specific for identifying infectious complications, although it was not as sensitive as testing for CRP. Pooled sensitivity was 0.75 (95% CI 0.63-0.84) for procalcitonin tests and 0.77 (95% CI 0.67-0.85) for CRP tests. Pooled specificity was 0.90 (95% CI 0.85-0.93) for procalcitonin tests and 0.56 (95% CI 0.25-0.83) for CRP tests. The positive likelihood ratio for procalcitonin (7.28 [95% CI 5.10-10.38]) was sufficiently high to qualify procalcitonin testing as a rule-in diagnostic tool, while the negative likelihood ratio (0.28 [95% CI 0.18-0.40]) was not sufficiently low to qualify procalcitonin testing as a reliable rule-out diagnostic tool. Conclusion Procalcitonin has higher diagnostic value than CRP for the detection of bacterial sepsis in patients with autoimmune disease, and the test for procalcitonin is more specific than sensitive. A procalcitonin test is not recommended to be used in isolation as a rule-out tool.

AB - Objective To systematically review evidence of the accuracy of the procalcitonin test for diagnosis of bacterial infection in patients with autoimmune disease. Methods The major databases Medline, EMBase, and the Cochrane Library were searched for studies published between January 1966 and October 2011 that evaluated procalcitonin, alone or in comparison with other laboratory markers such as C-reactive protein (CRP), as a diagnostic marker for bacterial infection in patients with autoimmune disease and provided sufficient data to permit construction of 2 × 2 tables. Results Nine studies were included in the final meta-analysis. The area under the summary receiver operating characteristic curve values were 0.91 (95% confidence interval [95% CI] 0.88-0.93) for procalcitonin and 0.81 (95% CI 0.78-0.84) for CRP. In general, testing for procalcitonin was highly specific for identifying infectious complications, although it was not as sensitive as testing for CRP. Pooled sensitivity was 0.75 (95% CI 0.63-0.84) for procalcitonin tests and 0.77 (95% CI 0.67-0.85) for CRP tests. Pooled specificity was 0.90 (95% CI 0.85-0.93) for procalcitonin tests and 0.56 (95% CI 0.25-0.83) for CRP tests. The positive likelihood ratio for procalcitonin (7.28 [95% CI 5.10-10.38]) was sufficiently high to qualify procalcitonin testing as a rule-in diagnostic tool, while the negative likelihood ratio (0.28 [95% CI 0.18-0.40]) was not sufficiently low to qualify procalcitonin testing as a reliable rule-out diagnostic tool. Conclusion Procalcitonin has higher diagnostic value than CRP for the detection of bacterial sepsis in patients with autoimmune disease, and the test for procalcitonin is more specific than sensitive. A procalcitonin test is not recommended to be used in isolation as a rule-out tool.

UR - http://www.scopus.com/inward/record.url?scp=84865638942&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865638942&partnerID=8YFLogxK

U2 - 10.1002/art.34512

DO - 10.1002/art.34512

M3 - Article

C2 - 22605405

AN - SCOPUS:84865638942

VL - 64

SP - 3034

EP - 3042

JO - Arthritis and Rheumatology

JF - Arthritis and Rheumatology

SN - 2326-5191

IS - 9

ER -