Abstract
Procalcitonin (PCT) has been widely investigated for its prognostic value in septic patients. However, studies have produced conflicting results. The purpose of the present meta-analysis is to explore the diagnostic accuracy of a single PCT concentration and PCT non-clearance in predicting all-cause sepsis mortality. We searched PubMed, Embase, Web of Knowledge and the Cochrane Library. Articles written in English were included. A 2 × 2 contingency table was constructed based on all-cause mortality and PCT level or PCT non-clearance in septic patients. Two authors independently evaluated study eligibility and extracted data. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. We used the Q-test and I 2 index to test heterogeneity. Twenty-three studies with 3,994 patients were included. An elevated PCT level was associated with a higher risk of death. The pooled relative risk (RR) was 2.60 (95% confidence interval (CI), 2.05–3.30) using a random-effects model (I 2 = 63.5%). The overall area under the summary receiver operator characteristic (SROC) curve was 0.77 (95% CI, 0.73–0.80), with a sensitivity and specificity of 0.76 (95% CI, 0.67–0.82) and 0.64 (95% CI, 0.52–0.74), respectively. There was significant evidence of heterogeneity for the PCT testing time (P = 0.020). Initial PCT values were of limited prognostic value in patients with sepsis. PCT non-clearance was a prognostic factor of death in patients with sepsis. The pooled RR was 3.05 (95% CI, 2.35–3.95) using a fixed-effects model (I 2 = 37.9%). The overall area under the SROC curve was 0.79 (95% CI, 0.75–0.83), with a sensitivity and specificity of 0.72 (95% CI, 0.58–0.82) and 0.77 (95% CI, 0.55–0.90), respectively. Elevated PCT concentrations and PCT non-clearance are strongly associated with all-cause mortality in septic patients. Further studies are needed to define the optimal cut-off point and the optimal definition of PCT non-clearance for accurate risk assessment.
Highlights
Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs [1]
The overall area under the summary receiver operator characteristic (SROC) curve was 0.79 (Fig 4B)
In this meta-analysis, we first determined that both single PCT concentrations and PCT nonclearance were strongly associated with all-cause mortality in septic patients
Summary
Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs [1]. Despite advances in antibiotic therapy and modern life support, the fatality rate of patients with sepsis has remained as high as 30%-60% worldwide [2,3]. An accurate assessment of patients at risk for poor clinical outcomes is challenging for clinicians. Clinical severity scores, such as the Acute Physiology and Chronic Health Evaluation (APACHEII) score and the Sequential Organ Failure Assessment (SOFA) score, have been validated for risk stratification in critical care settings [4,5]. A growing body of clinical research studies has identified blood biomarkers that may confer additional information to estimate disease progression in sepsis [6,7,8]
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