Procalcitonin Diagnostic Accuracy in CNS Bacterial Infections: A Comprehensive Analysis

The following is a summary of “Diagnostic Accuracy of Procalcitonin in Bacterial Infections of the CNS: An Updated Systematic Review, Meta-Analysis, and Meta-Regression,” published in the October 2023 issue of Critical Care by Biasucci et al.

Researchers started a retrospective study to assess the diagnostic accuracy of serum and cerebrospinal fluid (CSF) procalcitonin for CNS bacterial infections.

They searched MEDLINE, Cochrane Central Register of Controlled Trials, and International Web of Science database(January 1, 2016, to September 30, 2022). Randomized controlled trials and observational studies of procalcitonin as a biomarker for CNS infections were included. Studies were screened and data extracted independently in duplicate, and bias was assessed using the QUADAS-2 tool. Diagnostic sensitivity and specificity were combined using the appropriate model.

The results showed 5,347 citations identified in 23 studies. CSF procalcitonin had slightly better sensitivity, specificity, and positive likelihood ratio than serum procalcitonin. Among adults, the combined sensitivity of CSF procalcitonin was 0.89 (95% CI, 0.71–0.96) with a specificity of 0.81 (95% CI, 0.66–0.91), while serum procalcitonin had a pooled sensitivity of 0.82 (95% CI, 0.58–0.94) and a specificity of 0.77 (95% CI, 0.60–0.89). For children, CSF procalcitonin had higher sensitivity at 0.96 (95% CI, 0.88–0.99) and greater specificity at 0.91 (95% CI, 0.72–0.97), while serum procalcitonin exhibited a sensitivity of 0.90 (95% CI, 0.75–0.97) and specificity of 0.83 (95% CI, 0.67–0.92). Among post-neurosurgical patients, CSF procalcitonin had a pooled sensitivity of 0.82 (95% CI, 0.53–0.95) and a specificity of 0.81 (95% CI, 0.63–0.91), while serum procalcitonin exhibited a pooled sensitivity of 0.65 (95% CI, 0.33–0.88) and a specificity of 0.61 (95% CI, 0.41–0.78). Serum procalcitonin heterogeneity was higher than CSF procalcitonin. This heterogeneity stemmed from varying thresholds for the latter.

They concluded that CSF procalcitonin is superior to serum procalcitonin for diagnosing CNS bacterial infections in children and critical post-neurosurgical patients.

Source: journals.lww.com/ccmjournal/abstract/9900/diagnostic_accuracy_of_procalcitonin_in_bacterial.215.aspx