Meta-analysis of the value of the procalcitonin test for the diagnosis of meningitis in children

Objective To evaluate the value of the proealcitonin(PCT) test for diagnosing meningitis in children.Methods A comprehensive electronic search was performed to retrieve relevant studies on PCT in diagnosis of meningitis in children.The time from the initiation of the database to July 2013,QUADAS items was used to evaluate the quality of the included studies.Pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,summary receiver operating characteristic curve(SROC),and the heterogeneity of the included studies were analyzed by using the Meta-Disk software.Finally,the sensitivity analysis and analysis for heterogeneity cause were performed and Stata 12.0 software was used to assess the publication bias with funnel plot.Results A total of 12 literatures were reviewed,including 7 relevant English articles,5 Chinese articles.①The pooled sensitivity of procalcitonm test for the diagnosis of meningitis in children was 0.95(95% CI:0.92,0.97),the specificity was 0.89(95% CI:0.86,0.92),the positive likelihood ratio was 11.09(95% CI:5.73,21.49),and the negative likelihood ratio was 0.07(95% CI:0.05,0.11),diagnostic odds ratio was 122.01(95% CI:65.08,228.75).SROC area under the curve(AUC) was 0.977 7,Q*was0.933 0.②The sensitivity analysis of removing studies with sample capacity50,domestic and retrospective studies showed the confidence interval of the diagnostic parameters had a lot of overlapping with the original data.③Specificity,positive likelihood ratio had significant heterogeneity.Research areas,PCT test method and diagnostic criteria may not be the cause of heterogeneity of BM.④The sensitivity,specificity SROC AUC and Q*were the largest when cut-off point of 5 μg·L-1 was used for the the diagnosis of meningitis in children.Conclusion The use of PCT for the diagnosis of BM in children has a high sensitivity and specificity,but there is heterogeneity between the studies,PCT should be combined with specific clinical situations in the diagnosis of meningitis in children.