Precisión diagnóstica de la procalcitonina para la infección bacteriana en el servicio de Urgencias: una revisión sistemática

IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
A. Julián-Jiménez , L. García de Guadiana-Romualdo , G. Merinos-Sánchez , D.E. García
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引用次数: 0

Abstract

Introduction and objective

The care of patients with a suspected infectious process in hospital emergency departments (ED) accounts for 15%-35% of all daily care in these healthcare areas in Spain and Latin America. The early and adequate administration of antibiotic treatment (AB) and the immediate making of other diagnostic-therapeutic decisions have a direct impact on the survival of patients with severe bacterial infection. The main objective of this systematic review is to investigate the diagnostic accuracy of PCT to predict bacterial infection in adult patients treated with clinical suspicion of infection in the ED, as well as to analyze whether the different studies manage to identify a specific value of PCT as the most relevant from the diagnostic point of view of clinical decision that can be recommended for decision making in ED.

Method

A systematic review is carried out following the PRISMA regulations in the database of PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov from January 2005 to May 31, 2023 without language restriction and using a combination of MESH terms: “Procalcitonin”, “Infection/ Bacterial Infection/ Sepsis”, “Emergencies/ Emergency/ Emergency Department”, “Adults” and “Diagnostic”. Observational cohort studies (diagnostic performance analyses) were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the method used and the risk of bias of the included articles. No meta-analysis techniques were performed, but results were compared narratively.

Results

A total of 1,323 articles were identified, of which 21 that met the inclusion criteria were finally analyzed. The studies include 10,333 patients with 4,856 bacterial infections (47%). Eight studies were rated as high, 9 as moderate, and 4 as low. The AUC-ROC of all studies ranges from 0.68 (95% CI: 0.61-0.72) to 0.99 (95% CI: 0.98-1). The value of PCT 0.2-0.3 ng/ml is the most used and proposed in up to 12 of the works included in this review whose average estimated performance is an AUC-ROC of 0.79. If only the results of the 5 high-quality studies using a cut-off point of 0.2-0.3 ng/ml PCT are taken into account, the estimated mean AUC-COR result is 0.78 with Se:69% and Es:76%.

Conclusions

PCT has considerable diagnostic accuracy for bacterial infection in patients treated in ED for different infectious processes. The cut-off point of 0.25 (0.2-0.3) ng/ml has been positioned as the most appropriate to predict the existence of bacterial infection and can be used to help reasonably rule it out.

急诊科细菌感染的降钙素原诊断准确性:系统综述
导言和目标在西班牙和拉丁美洲,医院急诊科(ED)对疑似感染性疾病患者的治疗占急诊科所有日常治疗的 15%-35%。及早、充分地使用抗生素治疗(AB)并立即做出其他诊断治疗决定对严重细菌感染患者的存活率有直接影响。本系统性综述的主要目的是研究 PCT 预测急诊室临床怀疑感染的成人患者细菌感染的诊断准确性,并分析不同的研究是否能从临床决策的诊断角度确定 PCT 的特定值,并推荐用于急诊室的决策。方法 2005 年 1 月至 2023 年 5 月 31 日,按照 PRISMA 规定,在 PubMed、Web of Science、EMBASE、Lilacs、Cochrane、Epistemonikos、Tripdatabase 和 ClinicalTrials.gov 数据库中进行了系统性综述,没有语言限制,并使用了 MESH 术语组合:"降钙素原"、"感染/细菌感染/败血症"、"急症/急诊/急诊科"、"成人 "和 "诊断"。包括观察性队列研究(诊断性能分析)。采用纽卡斯尔-渥太华量表(NOS)评估所采用方法的质量和纳入文章的偏倚风险。结果共发现 1,323 篇文章,最终分析了其中 21 篇符合纳入标准的文章。这些研究涉及 10333 名患者,其中有 4856 例细菌感染(占 47%)。其中 8 项研究被评为高度研究,9 项研究被评为中度研究,4 项研究被评为低度研究。所有研究的 AUC-ROC 从 0.68(95% CI:0.61-0.72)到 0.99(95% CI:0.98-1)不等。PCT 值 0.2-0.3 纳克/毫升是使用最多的值,在本综述所包含的多达 12 项研究中都提出了这一值,其平均估计值为 AUC-ROC 0.79。如果仅考虑 5 项采用 0.2-0.3 纳克/毫升 PCT 临界点的高质量研究结果,则估计平均 AUC-COR 结果为 0.78,Se:69%,Es:76%。0.25(0.2-0.3)纳克/毫升的临界点被定位为预测细菌感染的最合适点,可用于帮助合理排除细菌感染。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Revista clinica espanola
Revista clinica espanola 医学-医学:内科
CiteScore
4.40
自引率
6.90%
发文量
73
审稿时长
28 days
期刊介绍: Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI). The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Nine issues are published each year, including mostly originals, reviews and consensus documents.
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