The diagnostic accuracy of procalcitonin in infectious patients after cardiac surgery: a systematic review and meta-analysis

Cardiac surgery with cardiopulmonary bypass (CPB) induces an acute inflammatory response that may lead to a systemic inflammatory response syndrome. The interest in procalcitonin (PCT) in the diagnosis of bacterial infection in patients after cardiac surgery remains less defined. The aim of this meta-analysis is to prospectively examine the discriminatory power of PCT as markers of infection in hospitalized patients with after cardiac surgery. The bivariate generalized nonlinear mixed-effect model and the hierarchical summary receiver operating characteristic model were used to estimate the pooled sensitivity, specificity and summary receiver operating characteristic curve. The pooled sensitivity and specificity were 0.81 (95% CI 0.75–0.87) and 0.78 (95% CI 0.73–0.83), respectively. The pooled positive likelihood ratio, and negative likelihood ratio of PCT were 3.74 (95% CI 2.98–4.69) and 0.24 (95% CI 0.17–0.32), respectively. The pooled area under the summary receiver operating characteristic curve of PCT using the HSROC method was 0.87 (95% CI 0.84– 0.90). This study indicated that PCT is a promising marker for the diagnosis of sepsis for those patients who undergo cardiac surgery.