Diagnostic Accuracy of Procalcitonin for Bacterial Infection in Liver Failure: A Meta-Analysis.

Xinchun He,Yuqing Feng,Haiou Chen,Baining Zhu,Caixia Yang,Liang Chen,Songwen Tan

doi:10.1155/2021/5801139

Abstract

The purpose of our studies was to systematically assess the accuracy and clinical value of plasma calcitonin in patients with liver failure complicated with bacterial infection. In this study, we included prospective observational studies or randomized controlled trials on PCT. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Heterogeneity, pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, the area under the summary receiver operating characteristic curve (SROC), and metaregression analysis were performed using Stata16.0 software. Consequently, the studies revealed substantial heterogeneity (I2 = 96, 95% confidence interval (95% CI) = 94–99). The results of meta-analysis using random effect models suggested that the combined DOR was 10.67 (95% CI = 3.73–30.53). In addition, the threshold effect analysis showed that the threshold effect was 0.23 and the correlation coefficient was −0.48, indicating that there was no threshold effect. In the forest map, the DOR of each study and the combined DOR are not distributed along the same line, and Q = 2.2 × 1014, P ≤ 0.001. Furthermore, the metaregression analysis of PCT study design, bacterial infection site, and mean age displayed that the P values were >0.05. The combined sensitivity was 0.77 (95% CI = 0.54–0.90), the combined specificity was 0.76 (95% CI = 0.70–0.82), the combined positive likelihood ratio was 3.25 (95% CI = 2.33–4.52), the combined negative likelihood ratio was 0.30 (95% CI = 0.14–0.67), and the combined AUC was 0.80 (95% CI = 0.76–0.83). In conclusion, PCT has moderate diagnostic value for adult liver failure complicated with bacterial infection, and it is a better auxiliary diagnostic index for liver failure with bacterial infection. However, the results of procalcitonin must be carefully interpreted combined with medical history, physical examination, and microbiological assessment.

Highlights

Liver failure is a kind of common end-stage liver disease in clinic with a high short-term mortality rate
It is caused by hepatitis B virus (HBV) and hepatitis C virus (HCV) or alcoholic hepatitis or hepatotoxic substances, etc., which leads to massive hepatocyte necrosis, cytokine storm, and systemic inflammatory response syndrome
It was of note that the pooled positive likelihood ratio (PLR) was 3.25, the negative likelihood ratio (NLR) was 0.30, and the diagnostic odds ratio (DOR) was 10.67 (Table 2). e wise square values for sensitivity, specificity, PLR, NLR, and DOR were 94.85, 80.99, 77.81, 95.09, and 100.00, respectively

Summary

Introduction

Liver failure is a kind of common end-stage liver disease in clinic with a high short-term mortality rate. It is caused by hepatitis B virus (HBV) and hepatitis C virus (HCV) or alcoholic hepatitis or hepatotoxic substances, etc., which leads to massive hepatocyte necrosis, cytokine storm, and systemic inflammatory response syndrome. Liver failure is more susceptible to infection and increased levels of circulating proinflammatory cytokines and chemokines due to immune damage, abnormal bacterial translocation, local ischemia, and hypoxia. Diagnosis of all these infections and SBP is a critical step in the management of patients with liver failure.

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