Procalcitonin to Distinguish Viral From Bacterial Pneumonia: A Systematic Review and Meta-analysis

• Published in: Clinical infectious diseases Vol. 70; no. 3; pp. 538 - 542
• Main Authors: Kamat, Ishan S, Ramachandran, Vignesh, Eswaran, Harish, Guffey, Danielle, Musher, Daniel M
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 16.01.2020
• Subjects: Anti-Bacterial Agents - therapeutic use; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections - diagnosis; Community-Acquired Infections - drug therapy; Humans; Pneumonia - diagnosis; Pneumonia - drug therapy; Pneumonia, Bacterial - diagnosis; Pneumonia, Bacterial - drug therapy; Procalcitonin; Protein Precursors; specificity; procalcitonin; sensitivity; pneumonia
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1093/cid/ciz545

Abstract Because of the diverse etiologies of community-acquired pneumonia (CAP) and the limitations of current diagnostic modalities, serum procalcitonin levels have been proposed as a novel tool to guide antibiotic therapy. Outcome data from procalcitonin-guided therapy trials have shown similar mortality, but the essential question is whether the sensitivity and specificity of procalcitonin levels enable the practitioner to distinguish bacterial pneumonia, which requires antibiotic therapy, from viral pneumonia, which does not. In this meta-analysis of 12 studies in 2408 patients with CAP that included etiologic diagnoses and sufficient data to enable analysis, the sensitivity and specificity of serum procalcitonin were 0.55 (95% confidence interval [CI], .37–.71; I2 = 95.5%) and 0.76 (95% CI, .62–.86; I2 = 94.1%), respectively. Thus, a procalcitonin level is unlikely to provide reliable evidence either to mandate administration of antibiotics or to enable withholding such treatment in patients with CAP. Serum procalcitonin levels are increasingly used to help diagnose and manage antibiotic treatment for community-acquired pneumonia. This meta-analysis suggests that serum procalcitonin levels are neither sufficiently specific nor sensitive to distinguish bacterial from viral pneumonia.