291 Procalcitonin for Detection of Serious Bacterial Infections in Children Presenting With Fever Without Source: A Systematic Review and Meta-analysis

Abstract

Study ObjectiveTo determine the usefulness of procalcitonin for early identification of young children at risk for severe bacterial infection among those presenting with fever without sourceDesignSystematic review and meta-analysis of diagnostic studies.Data sourcesSearches of Medline and Embase in December 2010.Study selectionDiagnostic studies that evaluated the diagnostic value of procalcitonin alone or compared with other laboratory markers, such as CRP or leukocyte count, to detect severe bacterial infection in children with fever without source on children aged between 7 days and 36 months were included.ResultsNine studies were included (2328 patients) for procalcitonin analysis, 7 (1389 patients) for CRP analysis, and 7 (1649 patients) for leukocyte analysis. Raised procalcitonin level (odds ratio [OR] 17.0; 95% confidence interval [CI] 7.4 to 39.2) was significantly associated with severe bacterial infection, as was raised CRP level (OR 9.9; 95% CI 7.2 to 13.6), and leukocytosis (OR 4.3; 95% CI 3.2 to 5.6). The random effect model was used for procalcitonin analysis because heterogeneity across studies existed. Overall sensitivity was 0.85 (0.75-0.92) for procalcitonin, 0.75 (0.67-0.82) for CRP, and 0.58 (0.47-0.67) for leukocyte count. Overall specificity was 0.74 (0.59-0.85) for PCT, 0.76 (0.68-0.82) for CRP, and 0.72 (0.67-0.77) for leukocyte count.ConclusionsView Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) Study ObjectiveTo determine the usefulness of procalcitonin for early identification of young children at risk for severe bacterial infection among those presenting with fever without source To determine the usefulness of procalcitonin for early identification of young children at risk for severe bacterial infection among those presenting with fever without source DesignSystematic review and meta-analysis of diagnostic studies. Systematic review and meta-analysis of diagnostic studies. Data sourcesSearches of Medline and Embase in December 2010. Searches of Medline and Embase in December 2010. Study selectionDiagnostic studies that evaluated the diagnostic value of procalcitonin alone or compared with other laboratory markers, such as CRP or leukocyte count, to detect severe bacterial infection in children with fever without source on children aged between 7 days and 36 months were included. Diagnostic studies that evaluated the diagnostic value of procalcitonin alone or compared with other laboratory markers, such as CRP or leukocyte count, to detect severe bacterial infection in children with fever without source on children aged between 7 days and 36 months were included. ResultsNine studies were included (2328 patients) for procalcitonin analysis, 7 (1389 patients) for CRP analysis, and 7 (1649 patients) for leukocyte analysis. Raised procalcitonin level (odds ratio [OR] 17.0; 95% confidence interval [CI] 7.4 to 39.2) was significantly associated with severe bacterial infection, as was raised CRP level (OR 9.9; 95% CI 7.2 to 13.6), and leukocytosis (OR 4.3; 95% CI 3.2 to 5.6). The random effect model was used for procalcitonin analysis because heterogeneity across studies existed. Overall sensitivity was 0.85 (0.75-0.92) for procalcitonin, 0.75 (0.67-0.82) for CRP, and 0.58 (0.47-0.67) for leukocyte count. Overall specificity was 0.74 (0.59-0.85) for PCT, 0.76 (0.68-0.82) for CRP, and 0.72 (0.67-0.77) for leukocyte count. Nine studies were included (2328 patients) for procalcitonin analysis, 7 (1389 patients) for CRP analysis, and 7 (1649 patients) for leukocyte analysis. Raised procalcitonin level (odds ratio [OR] 17.0; 95% confidence interval [CI] 7.4 to 39.2) was significantly associated with severe bacterial infection, as was raised CRP level (OR 9.9; 95% CI 7.2 to 13.6), and leukocytosis (OR 4.3; 95% CI 3.2 to 5.6). The random effect model was used for procalcitonin analysis because heterogeneity across studies existed. Overall sensitivity was 0.85 (0.75-0.92) for procalcitonin, 0.75 (0.67-0.82) for CRP, and 0.58 (0.47-0.67) for leukocyte count. Overall specificity was 0.74 (0.59-0.85) for PCT, 0.76 (0.68-0.82) for CRP, and 0.72 (0.67-0.77) for leukocyte count. ConclusionsView Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)