Procalcitonin Test in the Diagnosis of Bacteremia

A Meta-analysis

Alan E. Jones, James F. Fiechtl, Michael D. Brown, Jason J. Ballew, Jeffrey Kline

Research output: Contribution to journalArticle

161 Citations (Scopus)

Abstract

Study objective: We seek to evaluate the diagnostic performance of the procalcitonin test for the diagnosis of bacteremia in the emergency department (ED) population. Methods: We conducted a search of MEDLINE, bibliographies of previous systemic reviews, and pertinent national meeting research abstracts. We included studies that assessed the diagnostic accuracy of procalcitonin for bacteremia, with blood culture as the reference standard. We included prospective investigations of adults and children with suspected infection studied in the ED or at admission. Two authors independently extracted data and assessed study quality; consensus was reached by conference. The analysis was based on the I2 statistic for heterogeneity, unweighted summary receiver-operating characteristic curve, and random-effects pooled sensitivity and specificity across studies using the same test threshold. Results: The search yielded 348 publications and 1 unpublished study. Seventeen studies met the inclusion criteria and provided a sample of 2,008 subjects. There was a substantial degree of inconsistency (I2=64%). The unweighted summary receiver-operating characteristic curve provided the best overall estimate of test performance, with an area under the curve of 0.84 (95% confidence interval [CI] 0.75 to 0.90). Sensitivity analysis based on study quality did not significantly change the results. Subgroup analysis including only studies that used a test threshold of 0.5 or 0.4 ng/mL yielded pooled estimates for sensitivity and specificity of 76% (95% CI 0.66 to 0.84) and 70% (95% CI 0.60 to 0.79), respectively. Conclusion: We found the diagnostic performance of the procalcitonin test for identifying bacteremia in ED patients to be moderate. Future research designed to determine the utility of the procalcitonin test as a diagnostic tool used in isolation for detecting bacteremia in ambulatory patients is needed before widespread clinical use.

Original languageEnglish (US)
Pages (from-to)34-41
Number of pages8
JournalAnnals of Emergency Medicine
Volume50
Issue number1
DOIs
StatePublished - Jul 2007
Externally publishedYes

Fingerprint

Calcitonin
Bacteremia
Meta-Analysis
Hospital Emergency Service
Confidence Intervals
ROC Curve
Sensitivity and Specificity
Bibliography
MEDLINE
Area Under Curve
Publications
Infection
Research
Population

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Procalcitonin Test in the Diagnosis of Bacteremia : A Meta-analysis. / Jones, Alan E.; Fiechtl, James F.; Brown, Michael D.; Ballew, Jason J.; Kline, Jeffrey.

In: Annals of Emergency Medicine, Vol. 50, No. 1, 07.2007, p. 34-41.

Research output: Contribution to journalArticle

Jones, Alan E. ; Fiechtl, James F. ; Brown, Michael D. ; Ballew, Jason J. ; Kline, Jeffrey. / Procalcitonin Test in the Diagnosis of Bacteremia : A Meta-analysis. In: Annals of Emergency Medicine. 2007 ; Vol. 50, No. 1. pp. 34-41.
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