Procalcitonin to distinguish viral from bacterial pneumonia: A systematic review and meta-analysis

Ishan S Kamat, Vignesh Ramachandran, Harish Eswaran, Danielle Guffey, Daniel M Musher
Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America 2019 June 25
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 of 2,408 patients with CAP, that included etiologic diagnoses and sufficient data to enable analysis, the sensitivity and specificity of serum procalcitonin were 0.55 (95% CI = 0.37, 0.71; I2 = 95.5%) and 0.76 (95% CI = 0.62, 0.86; 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.

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