Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2025; 31(6): 99506
Published online Feb 14, 2025. doi: 10.3748/wjg.v31.i6.99506
Procalcitonin and presepsin for detecting bacterial infection and spontaneous bacterial peritonitis in cirrhosis: A systematic review and meta-analysis
Salisa Wejnaruemarn, Paweena Susantitaphong, Piyawat Komolmit, Sombat Treeprasertsuk, Kessarin Thanapirom
Salisa Wejnaruemarn, Piyawat Komolmit, Sombat Treeprasertsuk, Kessarin Thanapirom, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Paweena Susantitaphong, Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
Paweena Susantitaphong, Center of Excellence for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Piyawat Komolmit, Kessarin Thanapirom, Center of Excellence in Hepatic Fibrosis and Cirrhosis, Chulalongkorn University, Bangkok 10330, Thailand
Piyawat Komolmit, Kessarin Thanapirom, Excellence Center in Liver Diseases, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Author contributions: Wejnaruemarn S contributed to the design, acquisition, and writing of the manuscript; Susantitaphong P contributed to the statistical analyses and the writing of the manuscript; Komolmit P and Treeprasertsuk S contributed to the quality and profession revision of the manuscript; Thanapirom K contributed to the design, the quality and profession revision and the writing of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kessarin Thanapirom, Associate Professor, MD, PhD, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Rama 4 Road, Bangkok 10330, Thailand. kessarin.t@chula.ac.th
Received: July 25, 2024
Revised: November 23, 2024
Accepted: December 23, 2024
Published online: February 14, 2025
Processing time: 169 Days and 6.5 Hours
Abstract
BACKGROUND

Diagnosing bacterial infections (BI) in patients with cirrhosis can be challenging because of unclear symptoms, low diagnostic accuracy, and lengthy culture testing times. Various biomarkers have been studied, including serum procalcitonin (PCT) and presepsin. However, the diagnostic performance of these markers remains unclear, requiring further informative studies to ascertain their diagnostic value.

AIM

To evaluate the pooled diagnostic performance of PCT and presepsin in detecting BI among patients with cirrhosis.

METHODS

We performed a systematic search of the MEDLINE, EMBASE, and Scopus databases for studies that evaluated the diagnostic role of PCT and presepsin from inception to June 2024. Sensitivity and specificity values were pooled using a random effects model. BI was diagnosed based on clinical manifestations, physical examination, laboratory data, and radiological findings.

RESULTS

Of the 6639 articles retrieved, 28 met the inclusion criteria and included 4287 patients with 1789 cases of BI (41.7%). The bivariate pooled sensitivity and specificity estimates of PCT for BI diagnosis were 0.73 [95% confidence interval (CI): 0.64-0.81] and 0.83 (95%CI: 0.79-0.87), respectively. The diagnostic odds ratio (DOR) of PCT was 17.21 (95%CI: 9.57-30.95). Presepsin showed a pooled sensitivity of 0.75 (95%CI: 0.60-0.86), specificity of 0.80 (95%CI: 0.68-0.88), and DOR of 12.33 (95%CI: 5.10-29.83) for diagnosing BI. The pooled sensitivity and specificity of PCT for diagnosing spontaneous bacterial peritonitis (SBP) were 0.76 (95%CI: 0.67-0.84) and 0.87 (95%CI: 0.78-0.92), respectively. The positive likelihood ratio of PCT was 5.57 (95%CI: 3.34-9.29), which was sufficiently indicative of SBP. The DOR of PCT was 29.50 (95%CI: 12.30-70.80).

CONCLUSION

PCT and presepsin have high sensitivity and specificity for detecting BI in patients with cirrhosis. Furthermore, PCT has good diagnostic value as a rule-in test for SBP diagnosis.

Keywords: Biomarker; Cirrhosis; Infection; Meta-analysis; Presepsin; Procalcitonin; Soluble CD14

Core Tip: Our meta-analysis highlights the comparison between serum procalcitonin (PCT) and presepsin in the detection of bacterial infection (BI) among patients with cirrhosis. While both biomarkers demonstrated comparable sensitivity and specificity, PCT exhibited greater diagnostic ability for BI.