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Comparison of the diagnostic value of procalcitonin and C‐reactive protein after hematopoietic stem cell transplantation: a systematic review and meta‐analysis
Author(s) -
Lyu Y.X.,
Yu X.C.,
Zhu M.Y.
Publication year - 2013
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12055
Subject(s) - procalcitonin , medicine , confidence interval , meta analysis , hematopoietic stem cell transplantation , receiver operating characteristic , area under the curve , likelihood ratios in diagnostic testing , transplantation , gastroenterology , sepsis
Objective To conduct a systematic review and meta‐analysis of the performance of the procalcitonin ( PCT ) diagnostic test for identifying infectious complications after hematopoietic stem cell transplantation ( HSCT ). Methods We searched EMBASE , MEDLINE , the Cochrane database, and reference lists of relevant articles, with no language restrictions, through D ecember 2011. We selected original articles that reported diagnostic performance of PCT alone or compared with other biomarkers for identifying serious infections in HSCT recipients. We quantitatively evaluated test accuracy parameters with the use of forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random effect models. Results We found 6 qualifying studies (studying 1344 episodes of suspected infection with confirmed infectious episodes) from 3 countries. These 6 studies examined both PCT and C‐reactive protein ( CRP ) test performance. Bivariate pooled sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios were 0.66 (95% confidence interval [ CI ] 0.60–0.72), 0.72 (95% CI 0.65–0.79), 2.39 (95% CI 1.84– 3.09), and 0.47 (95% CI 0.39–0.57) for PCT , and 0.80 (95% CI 0.54–0.93), 0.73 (95% CI 0.56–0.86), 3.00 (95% CI 1.86–4.84), and 0.27 (95% CI 0.11–0.65) for CRP . In terms of area under the curve ( AUC ), CRP was superior to PCT in detecting infectious complications, with an AUC of 0.82 for CRP versus an AUC of 0.69 for PCT . Conclusion The pooled accuracy estimates of 6 different studies indicated only a moderate rule‐out diagnostic value of both PCT and CRP in discriminating infection from other inflammatory complications following allogeneic HSCT .