title: Diagnostic value of serum procalcitonin in solid organ transplant recipients: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a systematic review and meta-analysis to define the role of procalcitonin (PCT) in identifying infectious complication in organ transplant recipients.
  
  
  METHODS
  We searched EMBASE, MEDLINE, the Cochrane database, and reference lists of relevant articles, with no language restrictions, published from inception through May 2013. We selected original research that reported the diagnostic performance of PCT alone or when compared with other biomarkers to diagnose infectious complication among organ transplant recipients. 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 7 qualifying studies (studying 1226 episodes of suspected infection with 186 confirmed infectious episodes) from 4 countries. The patients were lung, kidney, liver, and heart transplant recipients. Bivariate pooled sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios for identification of bacterial infections in patients after transplantation were 85% (95% confidence interval [CI], 75%-92%), 81% (95% CI, 72%-88%), 4.41 (95% CI, 2.86-6.81), and 0.18 (95% CI, 0.10-0.33), respectively. Of the 4 studies that reported the experience of liver transplant patients, the pooled sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios were 90% (95% CI, 75%-97%), 85% (95% CI, 77%-91%), 6.12 (95% CI, 3.79-9.88), and 0.11 (95% CI, 0.04-0.32), respectively. There was no evidence of significant heterogeneity.
  
  
  CONCLUSIONS
  The existing literature suggests reasonable sensitivity and specificity for the PCT test in identifying infection complications among patients undergoing solid organ transplantation. Given the imperfect sensitivity and specificity of the PCT test, medical decisions should be based on both PCT test results and clinical findings.
authors: Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
authors: X-Y
authors: XY
authors: Yu
authors: Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
authors: Y
authors: Y
authors: Wang
authors: Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
authors: H
authors: H
authors: Zhong
authors: Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
authors: Q-L
authors: QL
authors: Dou
authors: Department of Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
authors: Y-L
authors: YL
authors: Song
authors: Xinjiang Key Lab of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China. Electronic address: Dr.wenhao@163.com.
authors: H
authors: H
authors: Wen
mesh_terms: D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016377:Organ Transplantation / Q000379:methods*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D066027:Transplant Recipients
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D007166:Immunosuppressive Agents; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide