Table 1.
PCT to discriminate invasive infections, fever of unknown origin.
| Study | Type | Population | n | Age | Aim | Gold standard | AUC | Cutoffa | Sn (%) | Sp (%) | PPV (%) | NPV (%) | Conclusions |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mahajan (2014)32 | P, M | ED, febrile fever of unknown origin | 226 SBI 30 |
<36 mo | PCT compared with traditional screening tests for detecting SBI | CRX, cultures | 0.80 | 0.6 | 51 | 93 | 13 | 86 | SBI = bacteremia, urinary tract infections, bacterial meningitis, lobar pneumonia, or bacterial enteritis. PCT is accurate for identifying young febrile infants and children with serious SBIs. |
| Luaces-Cubells (2012)30 | P, M | ED, febrile and non-toxic appearance | 868 IBI 15 |
1-36 mo | PCT for IBI | CRX, cultures | 0.87 | 0.9 | 86.7 | 90.5 | — | — | IBI = meningitis, bacteriemia oculta or sepsis. PCT as a useful biomarker to predict IBI in non-toxic-appearing children less than 3 years of age with fever without apparent focus and absence of leukocytes in urine. |
| Rey (2007)29 | P | PICU, all patients admitted | 94 | 0-14 y | PCT for detecting sepsis and to stratify according to severity | CRX, cultures | 0.91 | 1.16 | 92 | 76 | — | — | PCT is a better diagnostic marker of sepsis in critically ill children than CRP. |
| Lopez et al (2003)28 | P, M | ED, febrile children | 445 IBI 150 |
1-36 mo | PCT for distinguishing viral and bacterial infection and for early diagnosis of IBI | CRX, cultures microbial tests, DMSA | 0.95 | 0.59 | 91 | 94 | 90.8 | 90.1 | PCT offers better E than CRP for differentiating viral and bacterial cause of the fever and offers better Sn and Sp than CRP to differentiate IBI. |
| Gendrel (1999)34 | P | ED. Hospital admission for fever | 360 IBI 46 |
1 mo-15 y | PCT for distinguishing viral and bacterial infection | Microbial test and cultures | 0.94 | 1 | 83 | 93 | 86 | 91 | PCT was a better marker than CRP, IL-6, or IFN-alpha for distinguishing between bacterial and viral infections in children in the ED. PCT is a useful indicator of the severity of IBI |
| Chakravarti (2016)79 | R | CICU Infection suspected after CS | 98 | 0-21 y | PCT to distinguish between the presence or absence of IBI | CRX, cultures | 0.74 | 2 | 81.8 | 66.7 | 23.7 | 96.7 | All included patients were suspected of infection. PCT levels were higher in the confirmed IBI |
| Bobillo (2016)81 | P | NICU, after CS | 51 | <1 mo | Kinetics of PCT and its usefulness for diagnosis IBI | Clinical examination, CRX, cultures | 0.87 | 5 | 87.5 | 72.6 | 29 | 97.8 | No differences in PCT after CS with CPB and non-CPB. PCT could determine the absence of sepsis at 24 h after CS |
| Garcia (2012)39 | P | PICU, after CPB in CS | 231 | 1 mo-16 y | PCT to distinguish between SIRS and postsurgical infection after CPB | Clinical examination, CRX, cultures | 0.86 (48 h) | 4 | 62 | 87.9 | 61.5 | — | PCT after CPB is useful in the diagnosis of IBI. Values above the limit for each period should alert IBI to initiate or modify antibiotic treatment. |
Abbreviations: AUC, area under the curve; CAP, community acquired pneumonia; CICU, cardiac intensive care unit; CPB, cardiopulmonary bypass; CRP, C-reactive protein; CRX, chest x-ray; CS, cardiothoracic surgery; DMSA, 99mTc-dimercaptosuccinic acid; ED, emergency department; IBI, invasive bacterial infection; IFN, interferon; IL-6, interleukin 6; M, multicenter study; NICU, neonatal intensive care unit; NPV, negative predictive value; P, prospective study; PCT, procalcitonin; PICU, pediatric intensive care unit; PPV, positive predictive value; R, retrospective study; SBI, serious bacterial infection; SIRS, systemic inflammatory response syndrome; Sn, sensitivity; Sp, specificity.
Cutoff value for procalcitonin. Values expressed in ng/mL.