Comparison of the Diagnostic Accuracies of Procalcitonin and C-Reactive Protein for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: A Systematic Review and Meta-Analysis.

Background and

Objectives

Spontaneous bacterial peritonitis (SBP) is both a prevalent and severe complication among individuals with cirrhosis. This systematic review and meta-analysis was designed to evaluate the diagnostic accuracy of procalcitonin (PCT) and compare it to C-reactive protein (CRP) in cirrhotic patients with suspected SBP. Materials and

Methods

We performed an extensive literature review utilizing databases including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Original investigations reporting PCT diagnostic accuracy for SBP in cirrhotic populations were included. We computed pooled measures of sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and SROC curve area under the curve, with corresponding 95% confidence intervals (CIs).

Results

Meta-analytical synthesis encompassed twenty eligible studies. Diagnostic accuracy analysis revealed PCT sensitivity of 0.73 (95% CI, 0.61-0.83) and specificity of 0.88 (95% CI, 0.83-0.91). Likelihood ratio yielded positive values of 6.0 (95% CI, 4.1-8.8) and negative values of 0.30 (95% CI, 0.20-0.47). Overall discriminative ability, quantified through SROC curve analysis, demonstrated an AUC of 0.90 (95% CI, 0.87-0.92). Head-to-head comparisons between PCT and CRP were available from ten studies, demonstrating PCT's superior diagnostic accuracy over CRP, with significantly higher AUC values (PCT: 0.89, 95% CI 0.86-0.91; CRP: 0.74, 95% CI 0.70-0.78, p < 0.01).

Conclusions

Although PCT demonstrates higher diagnostic accuracy than CRP, it does not appear to provide sufficient accuracy to support treatment decisions for SBP. We recommend not relying solely on the PCT test and advise that it be interpreted in conjunction with clinical findings.