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
Abstract
1. Introduction
2. Materials and Methods
2.1. Data Sources and Searches
2.2. Study Selection
2.3. Data Extraction and Quality Assessment
2.4. Data Synthesis and Analysis
3. Results
3.1. Search Results
3.2. Study Characteristics
3.3. Quality Assessment
3.4. Primary Analysis of Overall Accuracy
3.5. Subgroup and Sensitivity Analyses
3.6. Head-to-Head Performance Analysis of PCT and CRP
3.7. Publication Bias
3.8. Certainty of Evidence
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
PCT | procalcitonin |
SBP | spontaneous bacterial peritonitis |
CRP | C-reactive protein |
SROC | summary receiver operating characteristic |
HSROC | hierarchical summary receiver operating characteristic |
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Pretest Probability | Post-test Probability After a Positive Result | Post-test Probability After a Negative Result | False Positive * | False Negative * |
---|---|---|---|---|
0.1 | 0.44 | 0.03 | 108 | 27 |
0.2 | 0.64 | 0.07 | 96 | 54 |
0.3 | 0.75 | 0.11 | 84 | 81 |
0.4 | 0.82 | 0.16 | 72 | 108 |
0.5 | 0.88 | 0.22 | 60 | 135 |
0.6 | 0.91 | 0.30 | 48 | 162 |
0.7 | 0.94 | 0.40 | 36 | 189 |
Subgroup | Number of Studies | Pooled Sensitivity (95% CI) | SUBGROUP p Value in Sensitivity | Pooled Specificity (95% CI) | SUBGROUP p Value in Specificity | Positive Likelihood Ratio | Negative Likelihood Ratio | Pooled AUC (95% CI) | Diagnostic Odds Ratio |
---|---|---|---|---|---|---|---|---|---|
Overall group | 20 | 0.73 (0.61–0.83) | - | 0.88 (0.83–0.91) | - | 6.0 (4.1–8.8) | 0.30 (0.20–0.47) | 0.90 (0.87–0.92) | 19.7 (9.6–40.5) |
PCT cutoff 0.5–1 (ng/mL) | 16 | 0.74 (0.58–0.85) | 0.87 | 0.87 (0.82–0.91) | 0.71 | 5.8 (3.7–9.0) | 0.30 (0.17–0.52) | 0.89 (0.86–0.92) | 19.2 (7.7–47.9) |
100% cirrhotic patients | 16 | 0.71 (0.58–0.81) | 0.35 | 0.85 (0.80–0.88) | 0.01 * | 4.6 (3.3–6.5) | 0.34 (0.23–0.52) | 0.87 (0.84–0.89) | 13.4 (6.7–26.8) |
Excluding case–control study | 19 | 0.74 (0.60–0.84) | 0.83 | 0.87 (0.82–0.91) | 0.42 | 5.8 (3.9–8.6) | 0.30 (0.19–0.48) | 0.90 (0.87–0.93) | 19.4 (9.1–41.5) |
Excluding studies using optimal cutoffs | 8 | 0.52 (0.37–0.67) | 0.01 * | 0.86 (0.79–0.91) | 0.57 | 3.8 (2.3–6.5) | 0.55 (0.40–0.77) | 0.82 (0.78–0.85) | 6.9 (3.1–15.3) |
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Tang, T.-H.; Lin, C.-M.; Niu, K.-Y.; Lin, S.-H.; Chen, C.-B.; Chuang, C.-L.; Yen, C.-C. 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. Medicina 2025, 61, 1134. https://doi.org/10.3390/medicina61071134
Tang T-H, Lin C-M, Niu K-Y, Lin S-H, Chen C-B, Chuang C-L, Yen C-C. 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. Medicina. 2025; 61(7):1134. https://doi.org/10.3390/medicina61071134
Chicago/Turabian StyleTang, Tzu-Hsuan, Ching-Min Lin, Kuang-Yu Niu, Shih-Hua Lin, Chen-Bin Chen, Chiao-Li Chuang, and Chieh-Ching Yen. 2025. "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" Medicina 61, no. 7: 1134. https://doi.org/10.3390/medicina61071134
APA StyleTang, T.-H., Lin, C.-M., Niu, K.-Y., Lin, S.-H., Chen, C.-B., Chuang, C.-L., & Yen, C.-C. (2025). 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. Medicina, 61(7), 1134. https://doi.org/10.3390/medicina61071134