The accuracy of the procalcitonin test for the diagnosis of neonatal sepsis: A meta-analysis

Department of Paediatrics, Nanjing Maternal and Child Health Hospital of Nanjing Medical University, Nanjing, China.
Scandinavian Journal of Infectious Diseases (Impact Factor: 1.5). 10/2010; 42(10):723-33. DOI: 10.3109/00365548.2010.489906
Source: PubMed


A meta-analysis was performed to assess the accuracy of the procalcitonin (PCT) test for diagnosing neonatal sepsis. The major databases, MEDLINE, EMBASE and the Cochrane Library were searched for studies published between January 1996 and May 2009 that evaluated PCT as a diagnostic marker for neonatal sepsis and provided sufficient data to calculate sensitivity and specificity. Twenty-two studies were included in the analysis. Trials that evaluated the PCT test for the diagnosis of early-onset neonatal sepsis at different time points (birth, 0-12 h, 12-24 h, and 24-48 h) and late-onset neonatal sepsis (LONS) all showed moderate accuracy (Q* = 0.79, 0.86, 0.81, 0.82, and 0.77, respectively). The PCT test was more accurate than the C-reactive protein (CRP) test for the diagnosis of LONS. A sensitivity analysis found that differences in PCT assay producer, gestational age and severity of sepsis in the study population may partially explain the between-studies heterogeneity. The PCT test showed moderate accuracy in diagnosing neonatal sepsis, regardless of differences in diagnostic criteria and time points for testing. For the diagnosis of LONS, the PCT test showed better accuracy than the CRP test. PCT is a valuable additional tool for the diagnosis of neonatal sepsis.

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    • "Therefore, neonatologists often begin early antibiotic treatment in newborn infants with risk factors for infection, exposing many neonates to unnecessary treatments. Due to the limitation of the treatment strategy in early diagnosis of sepsis, the isolation of causative organisms from microbiological cultures takes up to 72 h, which cannot be used to identify most infected infants [3]. "
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    ABSTRACT: Neonatal sepsis (NS) is an important cause of mortality in newborns and life-threatening disorder in infants. The meta-analysis was performed to investigate the diagnosis value of tumor necrosis factor- α (TNF- α ) test in NS. Our collectible studies were searched from PUBMED, EMBASE, and the Cochrane Library between March 1994 and August 2013. Accordingly, 347 studies were collected totally, in which 15 articles and 23 trials were selected to study the NS in our meta-analysis. The TNF- α test showed moderate accuracy of the diagnosis of NS both in early-onset neonatal sepsis (sensitivity = 0.66, specificity = 0.76, Q∗ = 0.74) and in late-onset neonatal sepsis (sensitivity = 0.68, specificity = 0.89, Q∗ = 0.87). We also found the northern hemisphere group in the test has higher sensitivity (0.84) and specificity (0.83). A diagnostic OR analysis found that the study population may be the major reason for the heterogeneity. Accordingly, we suggest that TNF- α is also a valuable marker in the diagnosis of NS.
    The Scientific World Journal 02/2014; 2014(12):471463. DOI:10.1155/2014/471463 · 1.73 Impact Factor
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    • "Till now, a large number of markers have been proposed for early diagnosis of sepsis [12], especially C-reactive protein (CRP) and procalcitonin (PCT). CRP is an acute-phase protein found in the blood that is produced by the liver because of infection or tissue injury, while PCT is a 116-amino acid peptide involved as a precursor in calcium homeostasis, and both of them have been widely used as useful markers for the diagnosis of neonatal sepsis [13] [14] [15] [16] [17]. However, the specificity and the value of CRP and PCT still have challenges; thus, there is a continuous need for searching for better biomarkers of sepsis. "
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    ABSTRACT: Neonatal sepsis (NS), a common disorder for humans, is recognized as a leading global public health challenge. This meta-analysis was performed to assess the accuracy of the serum amyloid A (SAA) test for diagnosing NS. The studies that evaluated the SAA test as a diagnotic marker were searched in Pubmed, EMBASE, the Cochrane Library, and Google Network between January 1996 and June 2013. A total of nine studies including 823 neonates were included in our meta-analysis. Quality of each study was evaluated by the quality assessment of diagnostic accuracy studies tool (QUADAS). The SAA test showed moderate accuracy in the diagnosis of NS both at the first suspicion of sepsis and 8-96 h after the sepsis onset, both with Q* = 0.91, which is similar to the PCT and CRP tests for the diagnosis of NS in the same period. Heterogeneity between studies was also explained by cut-off point, SAA assay, and age of included neonates. On the basis of our meta-analysis, therefore, SAA could be promising and meaningful in the diagnosis of NS.
    08/2013; 2013:520294. DOI:10.1155/2013/520294
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    • "Compared with CRP, procalcitonin has the advantage that it increases more rapidly; however, the significant rapid variations of basal levels after birth, and the need for several different cut-off values with changing neonatal age, have limited the diffusion of this marker in comparison to the CRP.21 Nevertheless, a recent meta-analysis suggested that procalcitonin showed better accuracy than the CRP test for the diagnosis of late-onset sepsis.22 "
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    ABSTRACT: Despite the advances in perinatal and neonatal care and use of newer potent antibiotics, the incidence of neonatal sepsis remains high and the outcome is still severe. For years, investigators have sought a test or panel of tests able to identify septic neonates accurately and rapidly in order to obtain an early diagnosis and develop a specific effective treatment for a successful outcome. In addition to the standard procedures (blood, CSF, and urine cultures), such panels have included a combination of haematological investigations (total, differential and immature cell counts), and levels of acute-phase reactants (principally CRP and procalcitonin), and cytokines (such as IL-6 or neutrophil CD64). Furthermore, the science of proteomics and genomics has been applied to the search for bio-markers, production of protein profiles and genetic polymorphisms that can rapidly help the prediction, early diagnosis, and treatment of human diseases, but, for now, data are as yet insufficient to confirm their validity.
    Pediatric reports 02/2011; 3(1):e1. DOI:10.4081/pr.2011.e1
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