title: Prognostic value of procalcitonin in pneumonia: A systematic review and meta-analysis.
abstract: This meta-analysis was performed to determine the accuracy of procalcitonin (PCT) in predicting mortality in pneumonia patients with different pathogenic features and disease severities. A systematic search of English-language articles was performed using PubMed, Embase, Web of Knowledge and the Cochrane Library to identify studies. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. The Q-test and I(2) index were used to test heterogeneity. A total of 21 studies comprising 6007 patients were included. An elevated PCT level was a risk factor for death from community-acquired pneumonia (CAP) (risk ratio (RR) 4.38, 95% confidence interval (CI) 2.98-6.43), particularly in patients with a low CURB-65 score. The commonly used cut-off, 0.5 ng/mL, had low sensitivity (SEN) and was not able to identify patients at high risk of dying. Furthermore, the PCT assay with functional SEN <0.1 ng/mL was necessary to predict mortality in CAP in the clinic. For critically ill patients, an elevated PCT level was associated with an increased risk of mortality (RR 4.18, 95% CI: 3.19-5.48). The prognostic performance was nearly equal between patients with ventilator-associated pneumonia (VAP) and patients with CAP.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China.|Medical School, Nankai University, Tianjin, China.|Department of Respiratory Medicine, Tianjin Medical University General Hospital, Tianjin, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Long-Xiang
authors.initials: LX
authors.lastname: Su
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China.|Medical School, Nankai University, Tianjin, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Guan
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Xiao
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China.
authors.forename: Li-Xin
authors.initials: LX
authors.lastname: Xie
mesh_terms: D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D016638:Critical Illness / Q000401:mortality; D006023:Glycoproteins / Q000097:blood; D006801:Humans; D011014:Pneumonia / Q000209:etiology / Q000401:mortality; D053717:Pneumonia, Ventilator-Associated / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: meta-analysis; mortality; pneumonia; procalcitonin; prognosis