Systematic review and meta-analysis of procalcitonin diagnostic accuracy in community-acquired bacteraemia
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Key Takeaway
Consider low procalcitonin cut-offs to exclude bacteraemia but combine with clinical assessment.
This systematic review and meta-analysis assessed the diagnostic accuracy of procalcitonin for community-acquired bacteraemia in adults. The analysis included data from 40 studies involving 192 529 patients, though 32 of these studies were judged to have a high risk of bias. Funding or conflicts of interest were not reported for this publication.
The primary outcome measured diagnostic accuracy using sensitivity, specificity, and the area under the summary receiver-operating curve. At a 0.10-ng/mL threshold, the pooled sensitivity was 93% with a 95% CI of 85-97%. The specificity was 36% with a 95% CI of 26-47%. The area under the summary receiver-operating curve for all studies was 0.80 with a 95% CI of 0.76-0.83% and a prediction interval of 0.57-0.91.
The authors note that a low cut-off value of procalcitonin can be useful to exclude community-acquired bacteraemia. This utility depends on the acceptable trade-off between sensitivity and specificity that the treating clinician considers. Procalcitonin may require combination with clinical characteristics for accurate assessment of bacteraemia risk and safely reducing unnecessary blood cultures. Follow-up duration was not reported in the source data.
View Original Abstract ↓
BACKGROUND: Procalcitonin is known to have moderate diagnostic accuracy for bacteraemia. A 2014 meta-analysis showed 76% sensitivity for a 0.50-ng/mL threshold. Lower thresholds might improve sensitivity.
OBJECTIVES: To determine the diagnostic accuracy of procalcitonin for community-acquired bacteraemia by conducting a systematic review and meta-analysis, focusing on the ability to exclude bacteraemia.
METHODS: Data sources: We searched PUBMED, EMBASE and Web of Science from 1 January 2014 to 20 May 2025.
STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: Articles studying diagnostic accuracy of procalcitonin for community-acquired bacteraemia in adults.
TEST AND REFERENCE STANDARD: Procalcitonin was compared with blood culture results.
ASSESSMENT OF RISK OF BIAS: Risk of bias was assessed using the QUADAS-2 tool.
METHODS OF DATA SYNTHESIS: We pooled sensitivity/specificity with a bivariate random-effects model and created a summary receiver-operating curve. The main analysis focused on studies reporting on a procalcitonin threshold of 0.10 ng/mL. In addition, we analysed results for all studies, studies with a 0.25-ng/mL and studies with a 0.50-ng/mL threshold.
RESULTS: We included 40 of 5450 identified articles, reflecting 192 529 patients of whom 31 480 (16%) had bacteraemia. Of 40 studies, 32 had high risk of bias. The pooled sensitivity for a 0.10-ng/mL threshold was 93% (95% CI: 85-97%) with a specificity of 36% (95% CI: 26-47%). The area under the summary receiver-operating curve for all studies was 0.80 (95% CI: 0.76-0.83%; prediction interval 0.57-0.91).
DISCUSSION: A low cut-off value of procalcitonin can be useful to exclude community-acquired bacteraemia, depending on what the treating clinician considers to be an acceptable trade-off between sensitivity and specificity. Procalcitonin may require combination with clinical characteristics for accurate assessment of the risk of bacteraemia and safely reducing unnecessary blood cultures.
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