Comparison of the Diagnostic Accuracies of Procalcitonin and C-Reactive Protein for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: A Systematic Review and Meta-Analysis
<i>Background and Objectives</i>: Spontaneous bacterial peritonitis (SBP) is both a prevalent and severe complication among individuals with cirrhosis. This systematic review and meta-analysis was designed to evaluate the diagnostic accuracy of procalcitonin (PCT) and compare it to C-rea...
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MDPI AG
2025-06-01
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| author | Tzu-Hsuan Tang Ching-Min Lin Kuang-Yu Niu Shih-Hua Lin Chen-Bin Chen Chiao-Li Chuang Chieh-Ching Yen |
| author_facet | Tzu-Hsuan Tang Ching-Min Lin Kuang-Yu Niu Shih-Hua Lin Chen-Bin Chen Chiao-Li Chuang Chieh-Ching Yen |
| author_sort | Tzu-Hsuan Tang |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Spontaneous bacterial peritonitis (SBP) is both a prevalent and severe complication among individuals with cirrhosis. This systematic review and meta-analysis was designed to evaluate the diagnostic accuracy of procalcitonin (PCT) and compare it to C-reactive protein (CRP) in cirrhotic patients with suspected SBP. <i>Materials and Methods</i>: We performed an extensive literature review utilizing databases including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Original investigations reporting PCT diagnostic accuracy for SBP in cirrhotic populations were included. We computed pooled measures of sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and SROC curve area under the curve, with corresponding 95% confidence intervals (CIs). <i>Results</i>: Meta-analytical synthesis encompassed twenty eligible studies. Diagnostic accuracy analysis revealed PCT sensitivity of 0.73 (95% CI, 0.61–0.83) and specificity of 0.88 (95% CI, 0.83–0.91). Likelihood ratio yielded positive values of 6.0 (95% CI, 4.1–8.8) and negative values of 0.30 (95% CI, 0.20–0.47). Overall discriminative ability, quantified through SROC curve analysis, demonstrated an AUC of 0.90 (95% CI, 0.87–0.92). Head-to-head comparisons between PCT and CRP were available from ten studies, demonstrating PCT’s superior diagnostic accuracy over CRP, with significantly higher AUC values (PCT: 0.89, 95% CI 0.86–0.91; CRP: 0.74, 95% CI 0.70–0.78, <i>p</i> < 0.01). <i>Conclusions</i>: Although PCT demonstrates higher diagnostic accuracy than CRP, it does not appear to provide sufficient accuracy to support treatment decisions for SBP. We recommend not relying solely on the PCT test and advise that it be interpreted in conjunction with clinical findings. |
| format | Article |
| id | doaj-art-375a59809b9042f2b4e3e71963af746e |
| institution | DOAJ |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-375a59809b9042f2b4e3e71963af746e2025-08-20T02:47:07ZengMDPI AGMedicina1010-660X1648-91442025-06-01617113410.3390/medicina61071134Comparison of the Diagnostic Accuracies of Procalcitonin and C-Reactive Protein for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: A Systematic Review and Meta-AnalysisTzu-Hsuan Tang0Ching-Min Lin1Kuang-Yu Niu2Shih-Hua Lin3Chen-Bin Chen4Chiao-Li Chuang5Chieh-Ching Yen6Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, TaiwanDepartment of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, TaiwanDepartment of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, TaiwanDepartment of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City 236, TaiwanDepartment of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, TaiwanChang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, TaiwanDepartment of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan<i>Background and Objectives</i>: Spontaneous bacterial peritonitis (SBP) is both a prevalent and severe complication among individuals with cirrhosis. This systematic review and meta-analysis was designed to evaluate the diagnostic accuracy of procalcitonin (PCT) and compare it to C-reactive protein (CRP) in cirrhotic patients with suspected SBP. <i>Materials and Methods</i>: We performed an extensive literature review utilizing databases including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Original investigations reporting PCT diagnostic accuracy for SBP in cirrhotic populations were included. We computed pooled measures of sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and SROC curve area under the curve, with corresponding 95% confidence intervals (CIs). <i>Results</i>: Meta-analytical synthesis encompassed twenty eligible studies. Diagnostic accuracy analysis revealed PCT sensitivity of 0.73 (95% CI, 0.61–0.83) and specificity of 0.88 (95% CI, 0.83–0.91). Likelihood ratio yielded positive values of 6.0 (95% CI, 4.1–8.8) and negative values of 0.30 (95% CI, 0.20–0.47). Overall discriminative ability, quantified through SROC curve analysis, demonstrated an AUC of 0.90 (95% CI, 0.87–0.92). Head-to-head comparisons between PCT and CRP were available from ten studies, demonstrating PCT’s superior diagnostic accuracy over CRP, with significantly higher AUC values (PCT: 0.89, 95% CI 0.86–0.91; CRP: 0.74, 95% CI 0.70–0.78, <i>p</i> < 0.01). <i>Conclusions</i>: Although PCT demonstrates higher diagnostic accuracy than CRP, it does not appear to provide sufficient accuracy to support treatment decisions for SBP. We recommend not relying solely on the PCT test and advise that it be interpreted in conjunction with clinical findings.https://www.mdpi.com/1648-9144/61/7/1134spontaneous bacterial peritonitisbiomarkerprocalcitoninC-reactive proteinmeta-analysis |
| spellingShingle | Tzu-Hsuan Tang Ching-Min Lin Kuang-Yu Niu Shih-Hua Lin Chen-Bin Chen Chiao-Li Chuang Chieh-Ching Yen Comparison of the Diagnostic Accuracies of Procalcitonin and C-Reactive Protein for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: A Systematic Review and Meta-Analysis Medicina spontaneous bacterial peritonitis biomarker procalcitonin C-reactive protein meta-analysis |
| title | Comparison of the Diagnostic Accuracies of Procalcitonin and C-Reactive Protein for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: A Systematic Review and Meta-Analysis |
| title_full | Comparison of the Diagnostic Accuracies of Procalcitonin and C-Reactive Protein for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: A Systematic Review and Meta-Analysis |
| title_fullStr | Comparison of the Diagnostic Accuracies of Procalcitonin and C-Reactive Protein for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Comparison of the Diagnostic Accuracies of Procalcitonin and C-Reactive Protein for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: A Systematic Review and Meta-Analysis |
| title_short | Comparison of the Diagnostic Accuracies of Procalcitonin and C-Reactive Protein for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: A Systematic Review and Meta-Analysis |
| title_sort | comparison of the diagnostic accuracies of procalcitonin and c reactive protein for spontaneous bacterial peritonitis in patients with cirrhosis a systematic review and meta analysis |
| topic | spontaneous bacterial peritonitis biomarker procalcitonin C-reactive protein meta-analysis |
| url | https://www.mdpi.com/1648-9144/61/7/1134 |
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