title: [Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: systematic review and metaanalysis].
abstract: OBJECTIVE
  To determine the role of plasma procalcitonin (PCT) levels in diagnosing ventilator-associated pneumonia.
  
  
  METHODS
  A systematic review of publications prospectively assessing the diagnostic role of PCT in ventilator-associated pneumonia was carried out. The search was performed using Medline, Embase, the Cochrane Collaboration and MEDION, with reviewing of the references of retrieved articles. We extracted data that allowed the calculation of sensitivity, specificity, likelihood ratios and diagnostic odds ratio. Intervention Metaregression was performed to determine whether exposure to previous antibiotic treatment, the time to occurrence of ventilator-associated pneumonia and the type of patients had an impact upon the diagnostic performance of procalcitonin.
  
  
  RESULTS
  Seven studies were considered (373 patients, 434 episodes). We found no publication bias or threshold effect. High plasma PCT levels were associated to an increased risk of suffering ventilator-associated pneumonia (OR: 8.39; 95% CI: 5.4-12.6). The pooled data on sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio found were 76% (69-82), 79% (74-84), 4.35 (2.48-7.62), 0.26 (0.15-0.46) and 17.9 (10.1-31.7), respectively. Diagnostic yield was modified by prior exposure to antibiotics (rDOR 0.11, 0.02-0.069), but not by the type of critically ill patient or the time to occurrence of ventilator-associated pneumonia.
  
  
  CONCLUSIONS
  Our results suggest that PCT provides additional information on the risk of VAP. Inclusion of PCT in diagnostic algorithms could improve their effectiveness.
authors.affiliation: Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: juancarlos.sotillo@salud.madrid.org.
authors.forename: J C
authors.initials: JC
authors.lastname: Sotillo-Díaz
authors.affiliation: Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Bermejo-López
authors.affiliation: Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: P
authors.initials: P
authors.lastname: García-Olivares
authors.affiliation: Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Peral-Gutiérrez
authors.affiliation: Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: Sancho-González
authors.affiliation: Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: J E
authors.initials: JE
authors.lastname: Guerrero-Sanz
mesh_terms: D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000097:blood* / Q000175:diagnosis*; D011498:Protein Precursors / Q000097:blood*
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: Diagnosis; Diagnostic metaanalysis; Diagnóstico; Metaanálisis de pruebas diagnósticas; Neumonía asociada a ventilación mecánica; Procalcitonin; Procalcitonina; Ventilator-associated pneumonia