Diagnostic accuracy of procalcitonin for bacterial pneumonia in children – a systematic review and meta-analysis

Abstract

Objective: The predictive role of procalcitonin for childhood bacterial pneumonia, a leading cause of death, is unclear. We aimed to evaluate the diagnostic accuracy of procalcitonin for childhood bacterial pneumonia.

Methods: Major bibliographic databases were searched from inception through September 2019 using pre-defined index terms, including ‘procalcitonin,’ ‘pneumonia’ and ‘children’. The study is reported according to Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies. Meta-analyses of the diagnostic accuracy and odds ratio of procalcitonin for bacterial pneumonia were conducted along with subgroup analyses for different cut-offs of procalcitonin. The Quality Assessment of Diagnostic Accuracy Studies 2 instrument was used to assess the methodologic quality of eligible studies.

Results: Twenty-five studies (with 2,864 patients) showed that procalcitonin for bacterial pneumonia had an overall sensitivity of 0.64 (95% confidence interval: 0.53–0.74), specificity of 0.72 (95% confidence interval: 0.64–0.79), positive likelihood ratio of 2.3 (95% confidence interval: 1.8–3.0) and negative likelihood ratio of 0.50 (95% confidence interval: 0.38–0.66), and Area Under the Receiver Operating Characteristics of 0.74 (95% confidence interval: 0.70–0.78). Using a cut-off of 0.5 ng/ml, Procalcitonin had a sensitivity of 0.68 (95% confidence interval: 0.50–0.82), specificity of 0.60 (95% confidence interval: 0.47–0.72), and Area Under the Receiver Operating Characteristics of 0.68 (95% confidence interval: 0.64–0.72). Using a cut-off of 2 ng/ml, procalcitonin had a sensitivity of 0.59 (95% confidence interval: 0.40–0.76), specificity of 0.71 (95% confidence interval: 0.58–0.81), and AUROC curve of 0.71 (95% confidence interval: 0.67–0.75). Elevated procalcitonin was not associated with increased odds of bacterial pneumonia (odds ratio: 1.36, 95% confidence interval: 0.81–1.92, p = .18). Quality assessment found minimal concerns for bias or applicability.

Conclusions: Given the moderate diagnostic accuracy of procalcitonin for bacterial pneumonia, we recommend that procalcitonin be used in conjunction with other findings for management and disposition of children with pneumonia.

Keywords:

• Pneumonia
• procalcitonin
• diagnostic accuracy
• meta-analysis

Acknowledgments

We thank the staff in Medical Wisdom Consulting Group for technical assistance in statistical analysis, and National Taiwan University Hospital Health Economics and Outcome Research Group for advice on study design.

Disclosure statement

The authors declare that they have no conflict of interest.

Author contributions

Dr. Tsou, and Dr. Deanehan conceptualised and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.

Mr. Rafael, Dr. Ma, Dr. Tsou, and Dr. Wang designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript.

Dr. Tsou conceptualised and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Table of contents summary

This meta-analysis suggests procalcitonin alone has an insufficient diagnostic accuracy for bacterial pneumonia in children.