Abstract：
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.
METHODS: 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. Observational cohort studies were included. 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 twelve 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.
METHODS: 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. Observational cohort studies were included. 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 twelve 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.
摘要：
目标：在西班牙和拉丁美洲的这些医疗保健地区，医院急诊科（ED）中疑似感染过程的患者的护理占所有日常护理的15％-35％。抗生素治疗（AB）的早期和充分施用以及立即做出其他诊断-治疗决定对严重细菌感染患者的生存有直接影响。本系统评价的主要目的是探讨PCT在临床怀疑感染的成人患者中预测细菌感染的诊断准确性。以及分析不同的研究是否能够从临床决策的诊断角度确定PCT的特定值是最相关的，可以推荐用于ED的决策。
方法：根据PubMed数据库中的PRISMA规定进行系统审查，WebofScience,EMBASE,丁香花,科克伦,认识论，Tripdatabase和ClinicalTrials.gov从2005年1月至2023年5月31日，没有语言限制，并使用MESH术语的组合：“降钙素原”，“感染/细菌感染/脓毒症”，\"紧急情况/紧急情况/急诊科\",“成人”和“诊断”。包括观察性队列研究（诊断性能分析）。使用纽卡斯尔-渥太华量表（NOS）评估所用方法的质量和纳入文章的偏倚风险。纳入观察性队列研究。没有进行荟萃分析技术，但结果进行了叙述比较。
结果：共确定了1,323篇文章，最终分析了其中符合纳入标准的21例。这些研究包括10333名患者，有4,856名细菌感染（47％）。八项研究被评为高，9为适度，4低。所有研究的AUC-ROC范围为0.68（95％CI：0.61-0.72）至0.99（95％CI：0.98-1）。PCT0.2-0.3ng/ml的值是本综述中最多使用和提出的十二项工作，其平均估计性能为AUC-ROC为0.79。如果仅考虑使用0.2-0.3ng/mlPCT截止点的5项高质量研究的结果，估计的平均AUC-COR结果为0.78，其中Se：69％，Es：76％。
结论：PCT对不同感染过程的ED患者的细菌感染具有相当的诊断准确性。0.25（0.2-0.3）ng/ml的截止点已被定位为最适合预测细菌感染的存在，并可用于帮助合理排除细菌感染。
方法：根据PubMed数据库中的PRISMA规定进行系统审查，WebofScience,EMBASE,丁香花,科克伦,认识论，Tripdatabase和ClinicalTrials.gov从2005年1月至2023年5月31日，没有语言限制，并使用MESH术语的组合：“降钙素原”，“感染/细菌感染/脓毒症”，\"紧急情况/紧急情况/急诊科\",“成人”和“诊断”。包括观察性队列研究（诊断性能分析）。使用纽卡斯尔-渥太华量表（NOS）评估所用方法的质量和纳入文章的偏倚风险。纳入观察性队列研究。没有进行荟萃分析技术，但结果进行了叙述比较。
结果：共确定了1,323篇文章，最终分析了其中符合纳入标准的21例。这些研究包括10333名患者，有4,856名细菌感染（47％）。八项研究被评为高，9为适度，4低。所有研究的AUC-ROC范围为0.68（95％CI：0.61-0.72）至0.99（95％CI：0.98-1）。PCT0.2-0.3ng/ml的值是本综述中最多使用和提出的十二项工作，其平均估计性能为AUC-ROC为0.79。如果仅考虑使用0.2-0.3ng/mlPCT截止点的5项高质量研究的结果，估计的平均AUC-COR结果为0.78，其中Se：69％，Es：76％。
结论：PCT对不同感染过程的ED患者的细菌感染具有相当的诊断准确性。0.25（0.2-0.3）ng/ml的截止点已被定位为最适合预测细菌感染的存在，并可用于帮助合理排除细菌感染。
