Diagnostic accuracy of procalcitonin for bacterial pneumonia in children–a systematic review and meta-analysis

Po Yang Tsou, John Rafael, Yu Kun Ma, Yu Hsun Wang, Shekhar Raj, Santiago Encalada, Julia K. Deanehan

Research output: Contribution to journalReview articlepeer-review

Abstract

Objective: The predictive role of procalcitonin for childhood bacterial pneumonia, a leading cause of death, is unclear. We aimed to evaluate the diagnostic accuracy of procalcitonin for childhood bacterial pneumonia. Methods: Major bibliographic databases were searched from inception through September 2019 using pre-defined index terms, including ‘procalcitonin,’ ‘pneumonia’ and ‘children’. The study is reported according to Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies. Meta-analyses of the diagnostic accuracy and odds ratio of procalcitonin for bacterial pneumonia were conducted along with subgroup analyses for different cut-offs of procalcitonin. The Quality Assessment of Diagnostic Accuracy Studies 2 instrument was used to assess the methodologic quality of eligible studies. Results: Twenty-five studies (with 2,864 patients) showed that procalcitonin for bacterial pneumonia had an overall sensitivity of 0.64 (95% confidence interval: 0.53–0.74), specificity of 0.72 (95% confidence interval: 0.64–0.79), positive likelihood ratio of 2.3 (95% confidence interval: 1.8–3.0) and negative likelihood ratio of 0.50 (95% confidence interval: 0.38–0.66), and Area Under the Receiver Operating Characteristics of 0.74 (95% confidence interval: 0.70–0.78). Using a cut-off of 0.5 ng/ml, Procalcitonin had a sensitivity of 0.68 (95% confidence interval: 0.50–0.82), specificity of 0.60 (95% confidence interval: 0.47–0.72), and Area Under the Receiver Operating Characteristics of 0.68 (95% confidence interval: 0.64–0.72). Using a cut-off of 2 ng/ml, procalcitonin had a sensitivity of 0.59 (95% confidence interval: 0.40–0.76), specificity of 0.71 (95% confidence interval: 0.58–0.81), and AUROC curve of 0.71 (95% confidence interval: 0.67–0.75). Elevated procalcitonin was not associated with increased odds of bacterial pneumonia (odds ratio: 1.36, 95% confidence interval: 0.81–1.92, p =.18). Quality assessment found minimal concerns for bias or applicability. Conclusions: Given the moderate diagnostic accuracy of procalcitonin for bacterial pneumonia, we recommend that procalcitonin be used in conjunction with other findings for management and disposition of children with pneumonia.

Original languageEnglish (US)
Pages (from-to)683-697
Number of pages15
JournalInfectious Diseases
Volume52
Issue number10
DOIs
StatePublished - Oct 2 2020

Keywords

  • Pneumonia
  • diagnostic accuracy
  • meta-analysis
  • procalcitonin

ASJC Scopus subject areas

  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

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