Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: Systematic review and metaanalysis

Abstract

ObjectiveTo determine the role of plasma procalcitonin (PCT) levels in diagnosing ventilator-associated pneumonia. DesignA systematic review of publications prospectively assessing the diagnostic role of PCT in ventilator-associated pneumonia was carried out. The search was performed using Medline, Embase, the Cochrane Collaboration and MEDION, with reviewing of the references of retrieved articles. We extracted data that allowed the calculation of sensitivity, specificity, likelihood ratios and diagnostic odds ratio. InterventionMetaregression was performed to determine whether exposure to previous antibiotic treatment, the time to occurrence of ventilator-associated pneumonia and the type of patients had an impact upon the diagnostic performance of procalcitonin. ResultsSeven studies were considered (373 patients, 434 episodes). We found no publication bias or threshold effect. High plasma PCT levels were associated to an increased risk of suffering ventilator-associated pneumonia (OR: 8.39; 95% CI: 5.4–12.6). The pooled data on sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio found were 76% (69–82), 79% (74–84), 4.35 (2.48–7.62), 0.26 (0.15–0.46) and 17.9 (10.1–31.7), respectively. Diagnostic yield was modified by prior exposure to antibiotics (rDOR 0.11, 0.02–0.069), but not by the type of critically ill patient or the time to occurrence of ventilator-associated pneumonia. ConclusionsOur results suggest that PCT provides additional information on the risk of VAP. Inclusion of PCT in diagnostic algorithms could improve their effectiveness.