The use of procalcitonin in the diagnosis of bone and joint infection: a systemic review and meta-analysis

Abstract

Only a few studies have investigated the use of PCT in the diagnosis of bone and joint infection, and these studies have had relatively small sample sizes. We performed a systematic review and meta-analysis of the diagnostic performance of serum procalcitonin (PCT) in the identification of osteomyelitis and septic arthritis in patients who present with fever and orthopedic symptoms. EMBASE, MEDLINE, and Cochrane databases and the reference lists of relevant articles were searched, with no language restrictions, through February 2012. All original studies that reported the use of serum PCT alone or in comparison with other biomarkers for diagnosis of osteomyelitis and septic arthritis were included. Seven studies qualified for inclusion. These studies enrolled a total of 583 patients with suspected bone or joint infection, 131 of whom had confirmed osteomyelitis or septic arthritis. Analysis of the PCT data indicated a bivariate pooled sensitivity of 0.67 (95 % CI: 0.37-0.88), specificity of 0.90 (95 % CI: 0.78-0.96), a positive likelihood ratio (LR+) of 6.48 (95 % CI: 2.28-14.6), and a negative likelihood ratio (LR-) of 0.37 (95 % CI: 0.16-0.84). Use of a lower PCT cut-off value (0.2-0.3 ng/mL) improved the LR + to 6.66 and the LR- to 0.15. Analysis of the three studies that also measured serum C-reactive protein (CRP) indicated that CRP had an LR + of 1.39 (95 % CI: 1.17-1.65) and an LR- of 0.40 (95 % CI: 0.12-1.36). Our results indicate that PCT may be more suitable as an aid for rule-in diagnosis rather than for exclusion of septic arthritis or osteomyelitis and that use of a lower cut-off value for serum PCT may improve its diagnostic performance.

Diagnostic and prognostic performances of serum procalcitonin in patients with bloodstream infections: A parallel, case-control study comprising adults and elderly

“…Soon later, several studies suggested that serum PCT could be used as a sensitive biomarker to detect or rule out BSIs in patients with suspected bacterial infections and systemic inflammatory response syndrome (SIRS). 7,8 Despite many studies and even some meta-analyses, the topic is still a matter of heated debate due to inconsistent findings. [9][10][11][12][13][14] Such heterogeneity might arise from using different subgroups of patients, 9 inconsistency in defining bacteremia and septicemia [10][11][12] and severe methodological flaws (such as using a small sample size and problematic grouping).…”

Clinical and Laboratory Diagnosis

“…Studies have shown that PCT levels are higher in patients with osteomyelitis then those with soft tissue or septic arthritis [ 79 ]. An elevated PCT at 0.4 ng/mL was 85.2 % sensitive and 87.3 % specifi c in diagnosing septic arthritis and acute osteomyelitis.…”

Evaluation of serum procalcitonin as a significant marker in cases of septic arthritis and osteomyelitis: a two year study

“…Few studies have already established the role of procalcitonin as a prognostic and diagnostic marker in bacterial indications and as a tool to start antibiotic administration. 5 The aim of the present study was to study the role of PCT in conditions of septic arthritis and Osteomyelitis with comparison to other markers like CRP. We also intend to calculate the sensitivity, specificity and predictive values of PCT in cases of Septic arthritis and Osteomyelitis.…”