Abstract
Backgrounds: Procalcitonin (PCT) and C-reactive protein (CRP) are widely used biomarkers in the assessment of febrile infants under 90 days of age. In Europe and the USA, PCT is typically favoured whereas CRP is favoured in the UK. The aim of this systematic review and meta-analysis is to report the test accuracy of PCT and CRP in identifying young infants with invasive and serious bacterial infections (SBI/IBI).
Methods: This systematic review and meta-analysis was registered with PROSPERO and the protocol written adherent to PRISMA-P standards. The full protocol is available as an open access publication. An electronic search of MEDLINE, EMBASE, Web of Science and The Cochrane Library was conducted. Eligible studies were selected and assessed for quality and generalisably using GRADE and QUADAS-2 tools. Data were extracted using a standardised data extraction tool. Pooled sensitivities and specificities and area under the curve (AUC) were calculated incorporating a range of cut-off values.
Results: 13 studies, involving 7497 participants, were included in the meta-analysis. The pooled sensitivity/specificity of PCT (>0.5ng/ml) to detect IBI was 0.76/0.85 and CRP (>20mg/L) was 0.65/0.81 respectively. For SBI, the pooled sensitivity/specificity of PCT was 0.52 /0.91 and CRP was 0.67/0.85 respectively. The AUC for diagnosis of IBI [0.86 for PCT, 0.77 for CRP, p=0.07] and SBI [0.83 for PCT, 0.82 for CRP, p=0.95]. The optimal cut-off value for PCT was 0.4ng/ml (IBI) and 0.17ng/ml (SBI).The optimal cut-off value for CRP was 12.4mg/L (IBI) and 17.6mg/L (SBI).
Conclusions/Learning Points: This review and meta-analysis is the largest review of its type including over 7000 infants. The AUC for PCT and CRP for identifying infants with IBI and SBI was not statistically different. This suggests that PCT is not superior to CRP as a biomarker in this age group.
Methods: This systematic review and meta-analysis was registered with PROSPERO and the protocol written adherent to PRISMA-P standards. The full protocol is available as an open access publication. An electronic search of MEDLINE, EMBASE, Web of Science and The Cochrane Library was conducted. Eligible studies were selected and assessed for quality and generalisably using GRADE and QUADAS-2 tools. Data were extracted using a standardised data extraction tool. Pooled sensitivities and specificities and area under the curve (AUC) were calculated incorporating a range of cut-off values.
Results: 13 studies, involving 7497 participants, were included in the meta-analysis. The pooled sensitivity/specificity of PCT (>0.5ng/ml) to detect IBI was 0.76/0.85 and CRP (>20mg/L) was 0.65/0.81 respectively. For SBI, the pooled sensitivity/specificity of PCT was 0.52 /0.91 and CRP was 0.67/0.85 respectively. The AUC for diagnosis of IBI [0.86 for PCT, 0.77 for CRP, p=0.07] and SBI [0.83 for PCT, 0.82 for CRP, p=0.95]. The optimal cut-off value for PCT was 0.4ng/ml (IBI) and 0.17ng/ml (SBI).The optimal cut-off value for CRP was 12.4mg/L (IBI) and 17.6mg/L (SBI).
Conclusions/Learning Points: This review and meta-analysis is the largest review of its type including over 7000 infants. The AUC for PCT and CRP for identifying infants with IBI and SBI was not statistically different. This suggests that PCT is not superior to CRP as a biomarker in this age group.
| Original language | English |
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| Publication status | Published - 09 May 2023 |
| Event | 41st Annual Meeting of the European Society of Paediatric Infectious Diseases 2023 - Lisbon, Portugal Duration: 08 May 2023 → 12 May 2023 https://2023.espidmeeting.org/ |
Conference
| Conference | 41st Annual Meeting of the European Society of Paediatric Infectious Diseases 2023 |
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| Abbreviated title | ESPID 2023 |
| Country/Territory | Portugal |
| City | Lisbon |
| Period | 08/05/2023 → 12/05/2023 |
| Internet address |