Prognostic value of procalcitonin in pneumonia: A systematic review and meta-analysis

Dan Liu, Long-Xiang Su, Wei Guan, Kun Xiao, Li-Xin Xie, Dan Liu, Long-Xiang Su, Wei Guan, Kun Xiao, Li-Xin Xie

Abstract

This meta-analysis was performed to determine the accuracy of procalcitonin (PCT) in predicting mortality in pneumonia patients with different pathogenic features and disease severities. A systematic search of English-language articles was performed using PubMed, Embase, Web of Knowledge and the Cochrane Library to identify studies. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. The Q-test and I(2) index were used to test heterogeneity. A total of 21 studies comprising 6007 patients were included. An elevated PCT level was a risk factor for death from community-acquired pneumonia (CAP) (risk ratio (RR) 4.38, 95% confidence interval (CI) 2.98-6.43), particularly in patients with a low CURB-65 score. The commonly used cut-off, 0.5 ng/mL, had low sensitivity (SEN) and was not able to identify patients at high risk of dying. Furthermore, the PCT assay with functional SEN <0.1 ng/mL was necessary to predict mortality in CAP in the clinic. For critically ill patients, an elevated PCT level was associated with an increased risk of mortality (RR 4.18, 95% CI: 3.19-5.48). The prognostic performance was nearly equal between patients with ventilator-associated pneumonia (VAP) and patients with CAP.

Keywords: meta-analysis; mortality; pneumonia; procalcitonin; prognosis.

© 2015 The Authors. Respirology published by Wiley Publishing Asia Pty Ltd on behalf of Asian Pacific Society of Respirology.

Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
a. Forest plot of procalcitonin (PCT) in predicting mortality in community‐acquired pneumonia (CAP). The overall pooled relative risk (RR) was 4.38 (95% CI: 2.98–6.43). b. Forest plot of PCT in predicting mortality in intensive care unit (ICU) patients with pneumonia. The overall pooled RR was 4.18 (95% CI: 3.19–5.48).
Figure 3
Figure 3
a. Forest plot of the sensitivity (SEN) and, specificity (SPE) of procalcitonin (PCT) in predicting mortality in community‐acquired pneumonia (CAP). The pooled SEN and SPE were 0.69 (95% CI: 0.57–0.79) and 0.74 (95% CI: 0.60–0.84), respectively. b. Forest plot of the SEN and SPE of PCT in predicting mortality in ICU patients with pneumonia. The pooled SEN and SPE were 0.80 (95% CI: 0.75–0.85) and 0.74 (95% CI: 0.63–0.82), respectively.
Figure 4
Figure 4
Summary receiver operator characteristic (SROC) graph of the included studies ((a) For CAP patients; (b) For ICU patients with pneumonia). ( Obsened Data; Summary Operating Point, SENS = 0.69 [0.57–0.79], SPEC = 0.74 [0.60–0.84]; SROC Cune, AUC = 0.77 [0.73–0.80]; 95% Confidence Contour; 95% Prediction Contour Obsened Data; Summary Operating Point, SENS = 0.80 [0.75–0.85], SPEC = 0.74 [0.63–0.82], SROC Cune, AUC = 0.83 [0.79–0.88]; 95% Confidence Contour, 95% Prediction Contour)

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