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Meta-Analysis
. 2015 Jun 15;10(6):e0129450.
doi: 10.1371/journal.pone.0129450. eCollection 2015.

Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis

Dan Liu  1 , Longxiang Su  2 , Gencheng Han  3 , Peng Yan  4 , Lixin Xie  4
Affiliations
Meta-Analysis

Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis

Dan Liu et al. PLoS One. .

Abstract

Procalcitonin (PCT) has been widely investigated for its prognostic value in septic patients. However, studies have produced conflicting results. The purpose of the present meta-analysis is to explore the diagnostic accuracy of a single PCT concentration and PCT non-clearance in predicting all-cause sepsis mortality. We searched PubMed, Embase, Web of Knowledge and the Cochrane Library. Articles written in English were included. A 2 × 2 contingency table was constructed based on all-cause mortality and PCT level or PCT non-clearance in septic patients. Two authors independently evaluated study eligibility and extracted data. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. We used the Q-test and I2 index to test heterogeneity. Twenty-three studies with 3,994 patients were included. An elevated PCT level was associated with a higher risk of death. The pooled relative risk (RR) was 2.60 (95% confidence interval (CI), 2.05-3.30) using a random-effects model (I(2) = 63.5%). The overall area under the summary receiver operator characteristic (SROC) curve was 0.77 (95% CI, 0.73-0.80), with a sensitivity and specificity of 0.76 (95% CI, 0.67-0.82) and 0.64 (95% CI, 0.52-0.74), respectively. There was significant evidence of heterogeneity for the PCT testing time (P = 0.020). Initial PCT values were of limited prognostic value in patients with sepsis. PCT non-clearance was a prognostic factor of death in patients with sepsis. The pooled RR was 3.05 (95% CI, 2.35-3.95) using a fixed-effects model (I(2) = 37.9%). The overall area under the SROC curve was 0.79 (95% CI, 0.75-0.83), with a sensitivity and specificity of 0.72 (95% CI, 0.58-0.82) and 0.77 (95% CI, 0.55-0.90), respectively. Elevated PCT concentrations and PCT non-clearance are strongly associated with all-cause mortality in septic patients. Further studies are needed to define the optimal cut-off point and the optimal definition of PCT non-clearance for accurate risk assessment.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of study selection.
Fig 2
Fig 2. Deek’s funnel plot asymmetry test for publication bias
(A. For single procalcitonin concentration; B. For procalcitonin non-clearance). Potential publication bias exists (P<0.05).
Fig 3
Fig 3. Forest plot of procalcitonin concentration to predict mortality in sepsis.
The overall pooled RR was 2.60 (95% CI, 2.05–3.30).
Fig 4
Fig 4. Summary receiver operating characteristic graph of the included studies
(A. For single procalcitonin concentration; B. For procalcitonin non-clearance).
Fig 5
Fig 5. Forest plot of procalcitonin non-clearance to predict mortality in sepsis.
The overall pooled RR was 3.05 (95% CI, 2.35–3.95).
See this image and copyright information in PMC

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