title: Significance of serum procalcitonin as biomarker for detection of bacterial peritonitis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Bacterial peritonitis is serious disease and remains a diagnostic challenge for clinicians. Many studies have highlighted the potential usefulness of procalcitonin (PCT) for identification of bacterial peritonitis, however, the overall diagnostic value of PCT remains unclear. Therefore, we performed a meta-analysis to assess the accuracy of PCT for detection of bacterial peritonitis.
  
  
  METHODS
  We performed a systematic searched in MEDLINE, EMBASE, SCOPUS, China Biology Medicine Database (CBM), China National Knowledge Infrastructure Database (CNKI) and Cochrane databases for trials that evaluated the diagnostic role of PCT for bacterial peritonitis. Sensitivity, specificity and other measures of accuracy of PCT were pooled using bivariate random effects models.
  
  
  RESULTS
  Eighteen studies involving 1827 patients were included in the present meta-analysis. The pooled sensitivity and specificity of serum PCT for the diagnosis bacterial peritonitis were 0.83 (95% CI: 0.76-0.89) and 0.92 (95% CI: 0.87-0.96), respectively. The positive likelihood ratio was 11.06 (95% CI: 6.31-19.38), negative likelihood ratio was 0.18 (95% CI: 0.12-0.27) and diagnostic odds ratio (DOR) was 61.52 (95% CI: 27.58-137.21). The area under the receiver operating characteristic curve (AUROC) was 0.94. Use of a common PCT cut-off value could improve the DOR to 75.32 and the AUROC to 0.95. Analysis of the seven studies that measured serum C-reactive protein (CRP) indicated that PCT was more accurate than CRP for the diagnosis of bacterial peritonitis.
  
  
  CONCLUSIONS
  Our results indicate that PCT determination is a relatively sensitive and specific test for the diagnosis of bacterial peritonitis. However, with regard to methodological limitations and significant heterogeneity, medical decisions should be based on both clinical findings and PCT test results.
authors.forename: Shi-kun
authors.initials: SK
authors.lastname: Yang
authors.forename: Li
authors.initials: L
authors.lastname: Xiao
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: Xiao-xuan
authors.initials: XX
authors.lastname: Xu
authors.forename: Pan-ai
authors.initials: PA
authors.lastname: Song
authors.forename: Fu-you
authors.initials: FY
authors.lastname: Liu
authors.affiliation: Department of Nephrology, The Second Xiangya Hospital, Kidney Institute of Central South University, Changsha, Hunan 410011, China. zndxsunlin11@163.com.
authors.forename: Lin
authors.initials: L
authors.lastname: Sun
mesh_terms: D000465:Algorithms; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002681:China; D006801:Humans; D016017:Odds Ratio; D010538:Peritonitis / Q000097:blood* / Q000175:diagnosis*; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D015203:Reproducibility of Results; 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