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Review
. 2021 May 8;11(5):846.
doi: 10.3390/diagnostics11050846.

Blood Procalcitonin Level as a Diagnostic Marker of Pediatric Bacterial Meningitis: A Systematic Review and Meta-Analysis

Heeyeon Kim  1 , Yun-Ho Roh  2 , Seo-Hee Yoon  1
Affiliations
Review

Blood Procalcitonin Level as a Diagnostic Marker of Pediatric Bacterial Meningitis: A Systematic Review and Meta-Analysis

Heeyeon Kim et al. Diagnostics (Basel). .

Abstract

Early diagnosis and treatment of bacterial meningitis in children are essential, due to the high mortality and morbidity rates. However, lumbar puncture is often difficult, and cerebrospinal fluid (CSF) culture takes time. This meta-analysis aims to determine the diagnostic accuracy of blood procalcitonin for detecting bacterial meningitis in children. We conducted a systematic search on electronic databases to identify relevant studies. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated, and a hierarchical summary receiver operating characteristic curve and area under the curve (AUC) were determined. Eighteen studies with 1462 children were included in the analysis. The pooled sensitivity, specificity, and the DOR of blood procalcitonin for detecting bacterial meningitis were 0.87 (95% confidence interval (CI): 0.78-0.93); 0.85 (95% CI: 0.75-0.91), and 35.85 (95% CI: 10.68-120.28), respectively. The AUC for blood procalcitonin was 0.921. Blood procalcitonin also showed higher diagnostic accuracy for detecting bacterial meningitis than other conventional biomarkers, including serum C-reactive protein and leukocyte count, CSF leukocyte and neutrophil count, and CSF protein and glucose levels. Blood procalcitonin can be a good supplemental biomarker with high diagnostic accuracy in detecting bacterial meningitis in children.

Keywords: bacterial meningitis; children; diagnosis; meta-analysis; procalcitonin; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The flow diagram of the search and selection process.
Figure 2
Figure 2
Summary of the risk of bias of the included studies (Quality assessment of the diagnostic accuracy studies-2, QUADAS-2).
Figure 3
Figure 3
Coupled forest plots for sensitivity and specificity.
Figure 4
Figure 4
Hierarchical summary receiver operating characteristic (HSROC) curve of the diagnostic performance of procalcitonin for diagnosing pediatric bacterial meningitis. The area under the curve of the HSROC was 0.921.
Figure 5
Figure 5
Deeks’ funnel plot for publication bias. ESS = effective sample size.
See this image and copyright information in PMC

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