title: Value of procalcitonin in differentiating pulmonary tuberculosis from other pulmonary infections: a meta-analysis.
abstract: OBJECTIVE
  To systematically and quantitatively summarise the current evidence on the utility of the procalcitonin test (PCT) in discriminating pulmonary tuberculosis (TB) from other pulmonary infections.
  
  
  METHODS
  We searched MEDLINE, EMBASE and the Cochrane database up to August 2013 for studies that reported the performance of PCT alone or compared with other biomarkers in diagnosing pulmonary TB. We summarised PCT using forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models.
  
  
  RESULTS
  We found nine qualifying studies covering 951 episodes of suspected TB along with 426 confirmed TB cases. The bivariate pooled sensitivity and specificity of PCT to distinguish TB from non-TB were respectively 42% (95%CI 30-56) and 87% (95%CI 63-96). The bivariate pooled sensitivity and specificity for PCT in distinguishing TB from bacterial pneumonia were respectively 78% (95%CI 67-86) and 85% (95%CI 78-90). Low heterogeneity was noted in studies comparing TB with bacterial pneumonia patients.
  
  
  CONCLUSIONS
  The results suggest consistently acceptable sensitivity and specificity of the PCT test in distinguishing TB from bacterial pneumonia. However, given the imperfect sensitivity and specificity of the test, medical decisions should be based on both the PCT test results as well as on clinical findings.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: S-L
authors.initials: SL
authors.lastname: Huang
authors.affiliation: Department of Anaesthesiology, Chang Gung Memorial Hospital, Taoyuan, and Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
authors.forename: H-C
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: C-W
authors.initials: CW
authors.lastname: Yu
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: H-C
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan and Chang Gung University College of Medicine, Taoyuan.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Wu
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou.
authors.forename: C-C
authors.initials: CC
authors.lastname: Lee
mesh_terms: D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis; D002116:Calcitonin / Q000032:analysis*; D015740:Calcitonin Gene-Related Peptide; D003937:Diagnosis, Differential; D006801:Humans; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000032:analysis*; D012372:ROC Curve; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000378:metabolism; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide