Diagnostic Accuracy of Procalcitonin in Bacterial Infections of the CNS: An Updated Systematic Review, Meta-Analysis, and Meta-Regression*
Authors' conclusion
In children and critical post-neurosurgical patients, CSF procalcitonin gains superior sensitivity and specificity compared with serum procalcitonin. Overall, CSF procalcitonin appears to have a higher pooled positive likelihood ratio compared with serum procalcitonin.
Study context
- Population
- Patients evaluated for CNS bacterial infections (adults, children, post-neurosurgical)23 studies
- Comparison
- Cerebrospinal fluid (CSF) procalcitonin vs serum procalcitonin
- Outcome
- Pooled diagnostic sensitivity and specificity for CNS bacterial infections
Methodological detailsbivariate or hierarchical model, risk of bias assessed with revised Quality Assessment for Studies of Diagnostic Accuracy tool, randomised and observational (prospective or retrospective) studies, MEDLINE, Cochrane CENTRAL, Web of Science searched January 1, 2016, to September 30, 2022; 5,347 citations identified
- Bivariate or hierarchical model
- Risk of bias assessed with revised Quality Assessment for Studies of Diagnostic Accuracy tool
- Randomised and observational (prospective or retrospective) studies
- MEDLINE, Cochrane CENTRAL, Web of Science searched January 1, 2016, to September 30, 2022; 5,347 citations identified
Pooled result
As reported in the abstract
Pooled sensitivity and specificity, adults
| Group | Sensitivity | Specificity |
|---|---|---|
| CSF procalcitonin | 0.89 (95% CI, 0.71-0.96) | 0.81 (95% CI, 0.66-0.91) |
| Serum procalcitonin | 0.82 (95% CI, 0.58-0.94) | 0.77 (95% CI, 0.60-0.89) |
Sensitivity
CSF procalcitonin0.89 (95% CI, 0.71-0.96)
Serum procalcitonin0.82 (95% CI, 0.58-0.94)
Specificity
CSF procalcitonin0.81 (95% CI, 0.66-0.91)
Serum procalcitonin0.77 (95% CI, 0.60-0.89)
Further pooled results
| Outcome | CSF procalcitonin | Serum procalcitonin |
|---|---|---|
| Pooled sensitivity and specificity, children (subgroup) | ||
| Sensitivity | 0.96 (95% CI, 0.88-0.99) | 0.90 (95% CI, 0.75-0.97) |
| Specificity | 0.91 (95% CI, 0.72-0.97) | 0.83 (95% CI, 0.67-0.92) |
| Pooled sensitivity and specificity, post-neurosurgical patients (subgroup) | ||
| Sensitivity | 0.82 (95% CI, 0.53-0.95) | 0.65 (95% CI, 0.33-0.88) |
| Specificity | 0.81 (95% CI, 0.63-0.91) | 0.61 (95% CI, 0.41-0.78) |
Between-study heterogeneity (meta-regression)
- Heterogeneity higher for serum than CSF procalcitonin; threshold variability a source of heterogeneity for CSF procalcitonin
Original publication
Diagnostic Accuracy of Procalcitonin in Bacterial Infections of the CNS: An Updated Systematic Review, Meta-Analysis, and Meta-Regression*. Crit Care Med. Published 19 October 2023. doi:10.
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