title: Role of procalcitonin in the diagnosis of infective endocarditis: a meta-analysis.
abstract: BACKGROUND
  Infective endocarditis (IE) is a diagnostic challenge. We aimed to systemically summarize the current evidence on the diagnostic value of procalcitonin (PCT) in identifying IE.
  
  
  METHODS
  We searched EMBASE, MEDLINE, Cochrane database, and reference lists of relevant articles with no language restrictions through September 2012 and selected studies that reported the diagnostic performance of PCT alone or compare with other biomarkers to diagnose IE. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effects models.
  
  
  RESULTS
  We found 6 qualifying studies that included 1006 episodes of suspected infection with 216 (21.5%) confirmed IE episodes from 5 countries. Bivariate pooled sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios were 64% (95% confidence interval [CI], 52%-74%), 73% (95% CI 58%-84%), 2.35 (95% CI 1.40-3.95), and 0.50 (95% CI 0.35-0.70), respectively. Of the 5 studies examining C-reactive protein (CRP), the pooled sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios were 75% (95% CI 62%-85%), 73% (95% CI 61%-82%), 2.81 (95% CI 1.70-4.65), and 0.34 (95% CI 0.19-0.60), respectively. The global measures of accuracy, area under the receiver operating characteristic curve (AUC) and diagnostic odds ratio (dOR), showed CRP (AUC 0.80, dOR 8.55) may have higher accuracy than PCT (AUC 0.71, dOR 4.67) in diagnosing IE.
  
  
  CONCLUSIONS
  Current evidence does not support the routine use of serum PCT or CRP to rule in or rule out IE in patients suspected to have IE.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chin-Wei
authors.initials: CW
authors.lastname: Yu
authors.forename: Ling-I
authors.initials: LI
authors.lastname: Juan
authors.forename: Shou-Chien
authors.initials: SC
authors.lastname: Hsu
authors.forename: Chun-Kuei
authors.initials: CK
authors.lastname: Chen
authors.forename: Chun-Wei
authors.initials: CW
authors.lastname: Wu
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Lee
authors.forename: Jiunn-Yih
authors.initials: JY
authors.lastname: Wu
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D004696:Endocarditis / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide