Diagnostic value of procalcitonin for articular infection in adults: a meta-analysis

doi:10.3969/j.issn.2095-4344.2017.31.027

Abstract

Abstract:

BACKGROUND: Due to special physiological characteristics, articular infection is difficult to be cured successfully. Early diagnosis is critical for the treatment of articular infection, thereafter, searching for a biomarker with high sensitivity and specificity is necessary.

OBJECTIVE: To systematically evaluate the value of procalcitonin for diagnosing joint infection in adult．

METHODS: A computer-based online research was performed for the literature in PubMed, EMbase, the Cochrane Library and CNKI databases from 1990 to June 2017. Literature screening and data extraction were conducted by two reviewers independently according to the inclusion and exclusion criteria. The risk of bias of included studies was assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2. Meta-analysis was then performed using Stata 14.0 software. The pooled weighted sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were calculated; the summary receiver operating characteristic curve was drawn and the area under the curve was calculated.

RESULTS AND CONCLUSION: (1) A total of 10 studies were included, involving 893 patients. (2) The pooled weighted sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of procalcitonin diagnosing joint infection were 0.82 (95%CI=0.72-0.89), 0.89 (95%CI=0.82-0.93), 7.20 (95%CI=4.6-11.3), 0.20 (95%CI=0.13-0.32), 35 (95%CI=18-71) and 0.92 (95%CI=0.90-0.94), respectively. (3) To conclude, procalcitonin exhibits more diagnostic efficiency for assessing articular infection in adults.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Osteoarthritis, Osteomyelitis, Calcitonin, Meta-Analysis, Tissue Engineering

CLC Number:

R318

Wang Ting-ting, Sun Wei-peng, Liang Shuang, Zhang Gui-yu, Zhou Chi, Zhu Mei-ling. Diagnostic value of procalcitonin for articular infection in adults: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(31): 5078-5084.

Figures/Tables 3

References

[1] 卓超, 钟南山. 骨关节外科相关感染国外指南述评[J]. 中华关节外科杂志(电子版), 2015,9(1):128-132.

[2] 张鑫, 李慧娟, 周亮, 等. 骨科术后感染临床治疗分析[J]. 实用药物与临床, 2016,19(1):58-61.

[3] 杨松, 张耀亭. PCT与感染相互关系的研究进展[J]. 临床肺科杂志, 2013,18(9):1666-1668.

[4] 杨明, 李新军, 麻雅婷, 等. PCT在不同病原体感染诊断中的研究进展[J]. 临床检验杂志(电子版), 2015,4(4):1003-1007.

[5] Foushee JA, Hope NH, Grace EE. Applying biomarkers to clinical practice: a guide for utilizing procalcitonin assays. J Antimicrob Chemother. 2012;67(11):2560-2569.

[6] 刘蓉华, 林文源. PCT检测在感染性疾病中的应用进展[J]. 医学综述, 2014,20(22):4106-4108.

[7] 王簕, 娄爱菊, 郭元, 等. 血清降钙素原鉴别成人化脓性关节炎与非化脓性关节炎的价值[J]. 广东医学, 2014,35(23):3646-3649.

[8] Fottner A, Birkenmaier C, von Schulze Pellengahr C, et al. Can serum procalcitonin help to differentiate between septic and nonseptic arthritis? Arthroscopy. 2008;24(2): 229-233.

[9] Hügle T, Schuetz P, Mueller B, et al. Serum procalcitonin for discrimination between septic and non-septic arthritis. Clin Exp Rheumatol. 2008;26(3):453.

[10] Maharajan K, Patro DK, Menon J, et al. Serum Procalcitonin is a sensitive and specific marker in the diagnosis of septic arthritis and acute osteomyelitis. J Orthop Surg Res. 2013;8:19.

[11] Martinot M, Sordet C, Soubrier M, et al. Diagnostic value of serum and synovial procalcitonin in acute arthritis: a prospective study of 42 patients. Clin Exp Rheumatol. 2005;23(3):303-310.

[12] Oppegaard O, Skodvin B, Halse AK, et al. CD64 as a potential biomarker in septic arthritis. BMC Infect Dis. 2013;13(1):278.

[13] Talebi-Taher M, Shirani F, Nikanjam N, et al. Septic versus inflammatory arthritis: discriminating the ability of serum inflammatory markers. Rheumatol Int. 2013;33(2):319-324.

[14] Yuan K, Li WD, Qiang Y, et al. Comparison of procalcitonin and C-reactive protein for the diagnosis of periprosthetic joint infection before revision total hip arthroplasty. Surg Infect (Larchmt). 2015;16(2):146-150.

[15] 张立营,沈伟,高鹏,等. 开放性骨折感染患者CD64指数白细胞介素-6和降钙素原测定的临床价值[J]. 山西医药杂志, 2016, 45(9):1100-1102.

[16] 解光越, 高惠丽, 高雯, 等. 血清降钙素原和C反应蛋白在骨折术后感染中的诊断价值[J]. 中国实验诊断学, 2014,18(10): 1713-1714.

[17] Paosong S, Narongroeknawin P, Pakchotanon R, et al. Serum procalcitonin as a diagnostic aid in patients with acute bacterial septic arthritis. Int J Rheum Dis. 2015;18(3):352-359.

[18] 秦杰,单仁飞,叶一冰,等. 血清降钙素原与C-反应蛋白水平检测对患者早期感染的诊断[J]. 中华医院感染学杂志, 2015,25(2): 271-272.

[19] 郭红明. 降钙素原对早期脓毒症诊断价值的研究[D]. 河北医科大学, 2014.

[20] 郑金菊, 张少强. PCT与CRP及白细胞计数对细菌感染性疾病诊断价值[J]. 青岛大学医学院学报, 2015,59(2):191-193.

[21] 戴万亨,张永涛. 诊断学[M]. 北京:中国中医药出版社, 2012: 282-283.

[22] 邵卫勇,陈淑丹,于小妹,等. 9024例血沉报告结果分析与探讨[J]. 中国卫生检验杂志, 2013,23(16):3288-3289.

[23] 李自军. 联合检测血沉、C-反应蛋白及降钙素原在关节置换术后感染的临床意义[J]. 中外医疗, 2016,35(14):13-16.

[24] 郭旗,郑稼,金毅,等. 血沉、C反应蛋白及ECT联合诊断假体周围感染临床研究[J]. 中华实用诊断与治疗杂志, 2010,24(3): 255-257.

[25] 任丽娟, 郑文亮, 艾根伟. 降钙素原与真菌血流感染的相关性研究[J]. 中华医院感染学杂志, 2011,21(24):5122-5124.

[26] 杜翠霞. 血清降钙素原和C反应蛋白水平在感染性疾病中的诊断价值[J]. 实用心脑肺血管病杂志, 2012,20(8):1366-1367.

[27] 闫立伟, 王文波, 李昭旭, 等. 血清降钙素原在诊断膝关节置换术后早期感染的意义[J]. 中国骨与关节杂志, 2015,14(4): 317-319.

[28] Schuetz P, Christ-Crain M, Müller B. Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections--hope for hype? Swiss Med Wkly.2009;139 (23-24):318-326.

[29] Limper M, de Kruif MD, Duits AJ, et al. The diagnostic role of procalcitonin and other biomarkers in discriminating infectious from non-infectious fever. J Infect. 2010;60(6):409-416.

[30] 降钙素原急诊临床应用专家共识组. 降钙素原(PCT)急诊临床应用的专家共识[J]. 中华急诊医学杂志, 2012,21(9):944-951.

[31] 汤瑾, 许静, 王坚镪, 等. 降钙素原联合C反应蛋白检测在血流感染早期临床诊断的应用[J]. 检验医学, 2013,28(8):662-665.

[32] 李满江, 王智勇, 张志强. 血清降钙素原在诊断关节置换术后早期感染的临床意义[J]. 中华骨与关节外科杂志, 2015,8(6): 546-548.

[33] 黄金河,谭颖,温贺龙,等. 降钙素原监测指导膝关节滑膜炎合理使用抗生素的临床研究[J]. 中国医学工程, 2016,42(8):41-43.

[34] 张俊, 徐志伟, 李克. 诊断性试验Meta分析的效应指标评价[J]. 中国循证医学杂志, 2013,13(7):890-895.

[35] 罗杰, 冷卫东. 系统评价/Meta分析理论与实践[G]. 2013.