Critical Care: Critical Care |

Prognostic Value of Procalcitonin in Sepsis and Pneumonia: A Systematic Review and Meta-analysis FREE TO VIEW

Dan Liu; Lixin Xie
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Chinese PLA General Hospital, Beijing, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A151. doi:10.1016/j.chest.2016.02.157
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SESSION TITLE: Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, April 17, 2016 at 02:15 PM - 03:45 PM

PURPOSE: We performed this meta-analysis to determine the diagnose accuracy of procalcitonin to predict mortality in patients suffering sepsis and different pathogenic features and disease severities of pneumonia.

METHODS: We systematically searched the PubMed, Embase, Web of Knowledge and Cochrane databases. The diagnostic value of procalcitonin in predicting prognosis was determined using a bivariate meta-analysis model. We used the Q-test and I2 index to test heterogeneity

RESULTS: 1) A total of 21 studies with a total of 6007 patients were included. Elevated procalcitonin level was a risk factor for death in community-acquired pneumonia (CAP) (RR 4.38, 95% CI 2.98-6.43), particularly in patients with a low CURB-65 score. The commonly used cut-off, 0.5ng/ml, had low sensitivity and was not able to identify patients at high risk of dying. The procalcitonin assay with a functional sensitivity < 0.1 ng/ml was necessary to predict mortality in CAP clinically. The prognostic performance was almost equally restricted to patients suffering from VAP and CAP. 2) An elevated PCT level and PCT non-clearance was associated with a higher risk of death in sepsis. The pooled relative risk (RR) was 2.60 (95% confidence interval (CI), 2.05-3.30) and 3.05 (95% CI, 2.35-3.95), respectively. 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.

CONCLUSIONS: 1) We found that elevated PCT levels and PCT non-clearance were associated with a higher risk of death in patients with sepsis. However, PCT may not be useful as a single index for assessing prognosis because of its moderate diagnostic accuracy, though it may be useful in combination with patients’ overall conditions and other clinical indexes. 2) For group of patients suffering mild CAP or with low mortality, the commonly used cut-off of 0.5 ng/ml had low sensitivity and could not be used to identify patients at high risk of dying. A more sensitive method assay should be used clinically when deciding whether to admit patients to the ICU or treat them as outpatients. For critically ill patients, an elevated PCT level was also associated with an increased risk of mortality. The prognostic performance was almost equally restricted to patients suffering from VAP and CAP.

CLINICAL IMPLICATIONS: We first statistically eveluated the prognostic value of PCT in sepsis and pneumonia.

DISCLOSURE: The following authors have nothing to disclose: Dan Liu, Lixin Xie

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