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Meta-Analysis
. 2022 Dec;44(1):81-93.
doi: 10.1080/0886022X.2021.2021236.

Diagnostic value of procalcitonin for bacterial infections in patients undergoing hemodialysis: a systematic review and meta-analysis

Mei Tao  1   2 , Danna Zheng  2   3 , Xudong Liang  2   3 , Qiang He  2   3 , Wei Zhang  2   3
Affiliations
Meta-Analysis

Diagnostic value of procalcitonin for bacterial infections in patients undergoing hemodialysis: a systematic review and meta-analysis

Mei Tao et al. Ren Fail. 2022 Dec.

Abstract

Background: The diagnostic value of procalcitonin (PCT) in patients undergoing hemodialysis (HD) remains unclear.

Methods: We searched multiple databases (PubMed, EMBASE, and Cochrane Library) for studies published through August 2021 that evaluated the diagnostic performance of PCT in patients undergoing HD and having suspected bacterial infections. The bivariate fixed effects model was used to calculate pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and summary receiver operating characteristic (SROC) curves.

Results: We identified a total of 1799 studies, of which seven diagnostic studies comprised 1444 patients and 430 bacterial infection episodes. Bivariate pooled sensitivity and specificity for PCT were 0.90 (95% CI: 0.85-0.94) and 0.83 (95% CI: 0.56-0.95), respectively. Furthermore, pooled DOR, PLR, NLR, and area under the curve (AUC) were 47 (95% CI: 11-209), 5.4 (95% CI: 1.7-16.9), 0.12 (95% CI: 0.07-0.20), and 0.92 (95% CI: 0.90-0.94), respectively. We also compared the diagnostic accuracy of PCT and C-reactive protein (CRP), and our results showed that the diagnostic accuracy parameters for PCT were significantly higher than those for CRP.

Conclusions: PCT is a useful marker for diagnosis of bacterial infections in patients undergoing HD at a cutoff value of 1.5 ng/ml.

Keywords: C-reactive protein; Procalcitonin; bacterial infections; renal dialysis; sensitivity and specificity.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Flow chart depicting study identification and inclusion.
Figure 2.
Figure 2.
Risk of bias and applicability concerns.
Figure 3.
Figure 3.
Forest plot of sensitivity and specificity for studies involving procalcitonin (PCT) (A) or C-reactive protein (CRP) (B) to detect bacterial infections in patients undergoing hemodialysis (HD).
Figure 4.
Figure 4.
Forest plot of positive likelihood ratio (PLR) and negative likelihood ratio (NLR) for studies involving procalcitonin (PCT) (A) or C-reactive protein (CRP) (B).
Figure 5.
Figure 5.
Summary receiver operating characteristic (SROC) curves for the diagnosis of bacterial infections in patients undergoing hemodialysis (HD). (A) Procalcitonin (PCT) and (B) C-reactive protein (CRP). AUC = area under the curve.
Figure 6.
Figure 6.
Forest plot of diagnostic odds ratio (OR) for studies involving procalcitonin (PCT) (A) or C-reactive protein (CRP) (B) to detect bacterial infections in patients undergoing hemodialysis (HD).
Figure 7.
Figure 7.
Fagan diagrams for (A) procalcitonin (PCT) and (B) C-reactive protein (CRP).
See this image and copyright information in PMC

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