Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study

Table 1

Characteristics of included studies.

Author	Year	Country	Setting	Medical contexts	Culture results	AUC for PCT (95% CI)	Episodes; patients	Male	Age^††; age range (yrs)
Yan [41]	2018	China	ICU and EICU	Nosocomial pneumonia	GN (163), GP (139)	0.71	302; reported 345 BCs from 286 patients	60%	73.5 (62–82) ; >18
Yan [40]	2017	China	Multidepartments	Sepsis	GN (254), GP (202)	0.63 (0.58-0.68)	456; reported 524 BCs from 414 patients	61%	70 (59–80) ; >18
Xu [39]	2019	China	Hematology	Hematologic malignancy	GN (217), other hemocultures (179 GPs + 6 fungi + 9 mixed + 2708 negatives = 2902)^‡‡	0.68 (0.64-0.72)	3118; 1115	60%	6.1; 1 mos–17.5 yrs
Xia [38]	2016	China	Hematology/Oncology Department	Fever^†	GN (154), other hemocultures (2665, included negative cultures)	0.66 (0.59-0.72)	2819; reported 3023 BCs from 992 children	61%	NR; 0.1-17.5
Vincenzi [37]	2016	Italy	Medical Oncology Department	Malignancy (febrile patients with solid metastatic or locally advanced tumor)	GN (130), other hemocultures ()	0.77	181; 181	55%	NR; 18-60 (34.6%), 61-70 (29.2%), >70 (36.2%)
Thomas [36]	2018	Germany	ICU	Sepsis (severe)	GN (815), other hemocultures (4043, included negative cultures)	0.72 (0.71-0.74)	4858; 4858	63%	70 (59-77); >18
Stoma [35]	2017	Belarus	Center of Hematology and Bone Marrow Transplantation	Malignancy, febrile neutropenia (after HSCT)	GN (30), other hemocultures (3 CMV + 1 Candida + 18 negatives = 22)	0.74 (0.57-0.87)	52; 52	46%	41 (28-51); 18-79
Shao [34]	2018	China	Multidepartments	Sepsis	GN (170), GP (209)	0.78	379; 379	60%	1; (4 d-13.3 yrs)
Prat [33]	2008	Spain	Hematology	Malignancy, febrile neutropenia	GN (5), other hemocultures (14 GPs + 38 negative cultures = 52)	0.86 (0.74-0.99)	57; 56	51%	47; (15-69) only one patient below 18
Oussalah [32]	2015	France	Multidepartments	Suspected BSI	GN (1067), other hemocultures (975 GPs + 401 other bacterial genera + 256 fungi + 30996 negatives = 34276)	0.75	35343; 35343	NR	49 (13-66); 0-102
Nishikawa [31]	2017	Japan	Multidepartments	Fever	GN rods (69), GP cocci (100)	0.87	169; 169	12%	66 (37-76) ; >18
Nakajima [30]	2014	Japan	Shock Trauma Center and Department of Respiratory Medicine	Sepsis	GN rods (6), GP cocci (8)	0.85	14; 14	78%	61.8 (11.2); >18
Luo [29]	2019	China	Hematology	Malignancy, febrile neutropenia	GN (268), other hemocultures ()	0.70 (0.67-0.74)	375; reported 1466 BCs from 396 patients	61%	38.0 (27-52) ; >14
Liu [28]	2017	China	Multidepartments	Sepsis	GN (91), GP (56)	0.73 (0.65-0.81)	147; 147	67%	59.3 (2.3); >18
Li [27]	2016	China	Multidepartments	Sepsis	GN (158), GP (140)	0.79 (0.74-0.84)	298; 298	65%	64.1 (19.4); >18
Leli [26]	2015	Italy	Multidepartments	Sepsis	GN (345), GP (217)	0.77 (0.73-0.81)	562; 562	59%	74 (62-83); >18
Kok [25]	2019	China	Multidepartments	Fever (suspected BSI)	GN (228), other hemocultures (GP + unspecified bacteremia = 658)	NR	886; 886	NR	NR; >18
Koivula [24]	2011	Finland	Hematology	Malignancy, febrile neutropenia	GN (10), other hemocultures (75, including negative cultures)^‡	0.77	85; 66	70%	56; 18-70
Gao [23]	2017	China	Multidepartments	Sepsis	GN (47), GP (45)	0.97	92; 92	58%	54.0 (8.0); 40-78
Fu [22]	2012	China	ICU	Sepsis	GN (23), Candida (20)	0.90	43; 43	63%	62.4 (2.8); >18
Fleischhack [21]	2000	Germany	Pediatric Hematology/Oncology Ward	Malignancy, febrile neutropenia	GN (13), other hemocultures (60 FUO + 28 localized infections + 13 pneumonias + 7 GPs + 1 fungus = 109)	NR	122; 51	61%	9; 0.7-31.8
Charles [20]	2008	France	ICU	Sepsis	GN (52), GP (45)	0.79 (0.71-0.88)	97; 92	64%	64.8 (15.3); >18
Cabral [19]	2018	Portugal	Burn unit	Sepsis (in burn patients)	GN (75), GP (114)	0.69 (0.61-0.77)	189; 189	59%	66 (GN group), 69 (GP group); >18
Brodska [18]	2013	Czech Republic	ICU	Sepsis	GN (78), GP and fungus (88)	0.871	166; 166	42%	64.5 (55-76); >18
Bilgili [17]	2018	Turkey	ICU	Sepsis	GN (76), GP (48)	0.80 (0.72-0.89)	124; 124	49%	56.3 (19.7); >18

Characteristics reported in a larger population in the original studies: Yan 2018 (286), Yan 2017 (414), Vincenzi (431), Prat (61), Nishikawa (852), Leli (1949), Luo (396). ^†Febrile patients included positive blood culture sepsis, clinical sepsis, nonsepsis infection, viral infection, and systemic fungal infection. ^‡Other febrile episodes included fever episodes with no bacteremia and Gram-positive bacteremia. 95% CI not available. ^††Ages were expressed as mean (SD) or median (IQR) or median. ^‡‡Proportion of mixed culture results was less than 0.5%. AUC: area under the receiver operating characteristic curve; CI: confidence interval; yrs: years; mos: months; ICU: intensive care unit; EICU: emergency intensive care unit; IQR: interquartile range; GN: Gram-negative; GP: Gram-positive; HSCT: hematopoietic stem cell transplantation; FUO: fever of unknown origin; NR: not reported.