Use of serum procalcitonin to detect bacterial infection in patients with autoimmune diseases: A systematic review and meta-analysis
Article first published online: 27 AUG 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 64, Issue 9, pages 3034–3042, September 2012
How to Cite
Wu, J.-Y., Lee, S.-H., Shen, C.-J., Hsieh, Y.-C., Yo, P.-H., Cheng, H.-Y., Chan, R.-C., Lee, C.-C. and Chang, S.-S. (2012), Use of serum procalcitonin to detect bacterial infection in patients with autoimmune diseases: A systematic review and meta-analysis. Arthritis & Rheumatism, 64: 3034–3042. doi: 10.1002/art.34512
- Issue published online: 27 AUG 2012
- Article first published online: 27 AUG 2012
- Accepted manuscript online: 17 MAY 2012 02:30PM EST
- Manuscript Accepted: 17 APR 2012
- Manuscript Received: 5 DEC 2011
- National Science Council. Grant Number: 100-2341-B-002-138-MY3NSC
To systematically review evidence of the accuracy of the procalcitonin test for diagnosis of bacterial infection in patients with autoimmune disease.
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.
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.
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.