Photo Credit: Md Saiful Islam Khan
The following is a summary of “Procalcitonin for the diagnosis of postoperative bacterial infection after adult cardiac surgery: a systematic review and meta-analysis,” published in the February 2024 issue of Critical Care by Nicolotti et al.
Cardiac surgery patients face infection risks, highlighting the need for a reliable, non-invasive tool like procalcitonin (PCT) to aid in rapid diagnosis. Still, its effectiveness in this population remains unclear.
Researchers conducted a retrospective analysis to pinpoint the accuracy of PCT in diagnosing bacterial infections after cardiac surgery.
They involved adult cardiac surgery patients to determine test accuracy. PubMed, EmBase, and WebOfScience were searched on April 12, 2023, and again on September 15, 2023, covering the past decade. The QUADAS-2 tool was assessed for quality. Pooled performance and diagnostic accuracy, with 95% CI, were calculated via a bivariate regression model. A meta-analysis using multiple thresholds within a random effects model was conducted to address reported threshold variations utilizing the diameter R-package.
The results showed 11 studies, while 10 (with 2984 patients) were included in the meta-analysis. All studies had a single-center observational design, with 5 having retrospective data collection. A quality assessment revealed various issues, primarily concerning the absence of prespecified thresholds for the index test in all studies. Bivariate model analysis using multiple thresholds within a study identified the optimal threshold at 3 ng/mL, with a mean sensitivity of 0.67 (95% CI 0.47–0.82), mean specificity of 0.73 (95% CI 0.65–0.79), and AUC of 0.75 (95% CI 0.29–0.95). Evaluating PCT’s predictive capability, the positive predictive value was at most close to 50%, even with a high prevalence (30%), while the negative predictive value was always > 90% when prevalence was < 20%.
They concluded that PCT might aid in ruling out infection after cardiac surgery, but more extensive trials are needed to confirm its real-world impact.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04824-3
