title: Diagnostic Accuracy of Serum Procalcitonin for Spontaneous Bacterial Peritonitis Due to End-stage Liver Disease: A Meta-analysis.
abstract: Early diagnosis and prompt treatment of spontaneous bacterial peritonitis (SBP) due to end-stage liver disease is vital to shorten hospital stays and reduce mortality. Many studies have explored the potential usefulness of serum procalcitonin (PCT) in predicting SBP. The aim of this study is to evaluate the overall diagnostic accuracy of PCT levels for identifying SBP due to end-stage liver disease.After performing a systematic search of the Medline, Embase, and Cochrane databases for studies that evaluated the diagnostic role of PCT for SBP, sensitivity, specificity, and other measures of accuracy of PCT concentrations in serum for SBP diagnosis were pooled using random-effects models. A summary receiver operating characteristic curve was used to summarize overall test performance.Seven publications met the inclusion criteria covering 742 episodes of suspected SBP along with 339 confirmed cases. The summary estimates for serum PCT in the diagnosis of SBP attributable to end-stage liver disease were: sensitivity 0.82 (95% CI 0.79-0.87), specificity 0.86 (95% CI 0.82-0.89), positive likelihood ratio 4.94 (95% CI 2.28-10.70), negative likelihood ratio 0.22 (95% CI 0.10-0.52), and diagnostic OR 22.55 (95% CI 7.01-108.30). The area under the curve was 0.92. There was evidence of significant heterogeneity but no evidence of publication bias.Serum PCT is a relatively sensitive and specific test for the identification of SBP. However, due to the limited high-quality studies available, medical decisions should be carefully made in the context of both PCT test results and other clinical findings.
authors.affiliation: From the Department of Gastroenterology, The 306th Hospital of PLA, Chaoyang District, Beijing, China.
authors.forename: Yongtao
authors.initials: Y
authors.lastname: Yang
authors.forename: Lianyong
authors.initials: L
authors.lastname: Li
authors.forename: Changmin
authors.initials: C
authors.lastname: Qu
authors.forename: Bolun
authors.initials: B
authors.lastname: Zeng
authors.forename: Shuwen
authors.initials: S
authors.lastname: Liang
authors.forename: Zhiwen
authors.initials: Z
authors.lastname: Luo
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Wang
authors.forename: Changqing
authors.initials: C
authors.lastname: Zhong
mesh_terms: D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016208:Databases, Factual; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D010538:Peritonitis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide