title: Role of procalcitonin in the diagnosis of severe infection in pediatric patients with fever and Neutropenia--a systemic review and meta-analysis.
abstract: OBJECTIVE
  The aim of this study was to determine the accuracy of the procalcitonin (PCT) test for diagnosis of bacterial sepsis in pediatric cancer patients with febrile neutropenia.
  
  
  METHODS
  Three major databases, MEDLINE, EMBASE and the Cochrane Library were searched for studies that evaluated the diagnostic value of PCT alone or compared with other laboratory markers such as C-reactive protein (CRP) to identify bacterial sepsis in children with fever and neutropenia. A bivariate model was used to derive summary sensitivity and specificity of the diagnostic tests.
  
  
  RESULTS
  A total of 10 studies looking into PCT tests and 8 studies looking into CRP tests were included in the final analysis. The prevalence of bacterial sepsis was 304 of 1031 (29.5%) in PCT studies and 741 of 1316 (56.3%) in CRP studies. In terms of area under the receiver operating characteristic curve, PCT had comparable discrimination to CRP (area under the curve: 0.75 versus 0.74). PCT was not as sensitive as the CRP test. The pooled sensitivity of PCT was 0.59 (95% confidence interval [CI]: 0.42-0.74) as compared with 0.75 (95% CI: 0.61-0.85) for CRP. PCT was more specific than sensitive whereas CRP was more sensitive than specific in this population. The pooled specificity was 0.76 (95% CI: 0.64-0.85) for PCT and 0.62 (95% CI: 0.49-0.73) for CRP. PCT had greater likelihood ratio positive (2.50; 95% CI: 1.64-3.81), making it the better rule-in test.
  
  
  CONCLUSIONS
  Of three markers potentially useful for diagnosing bacterial sepsis in children with fever and neutropenia, PCT had comparable diagnostic accuracy to CRP.
authors.affiliation: Department of Medical HAI Control, Guangdong General Hospital,106 Zhongshan Er Road, Guangzhou, 510080 China.
authors.forename: Shu-Guang
authors.initials: SG
authors.lastname: Lin
authors.forename: Tie-Ying
authors.initials: TY
authors.lastname: Hou
authors.forename: De-Hong
authors.initials: DH
authors.lastname: Huang
authors.forename: Shao-Yu Ru
authors.initials: SY
authors.lastname: He
authors.forename: Yu Deng
authors.initials: YD
authors.lastname: Lin
authors.forename: Li-Yan
authors.initials: LY
authors.lastname: Zhang
authors.forename: Pei-Shan
authors.initials: PS
authors.lastname: Hsieh
mesh_terms: D016470:Bacteremia / Q000175:diagnosis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005335:Fever of Unknown Origin / Q000175:diagnosis*; D006801:Humans; D009503:Neutropenia / Q000150:complications*; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000175:diagnosis*; D013223:Statistics as Topic
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide