The diagnostic accuracy of procalcitonin for community-acquired bacteraemia: an updated systematic review and meta-analysis

Abstract

Background Procalcitonin is known to have moderate diagnostic accuracy for bacteraemia. A 2014 meta-analysis showed 76% sensitivity for a 0.50-ng/mL threshold. Lower thresholds might improve sensitivity. Objectives To determine the diagnostic accuracy of procalcitonin for community-acquired bacteraemia by conducting a systematic review and meta-analysis, focusing on the ability to exclude bacteraemia. Methods Data sources: We searched PUBMED, EMBASE and Web of Science from 1 January 2014 to 20 May 2025. Study eligibility criteria and participants Articles studying diagnostic accuracy of procalcitonin for community-acquired bacteraemia in adults. Test and reference standard Procalcitonin was compared with blood culture results. Assessment of risk of bias Risk of bias was assessed using the QUADAS-2 tool. Methods of data synthesis We pooled sensitivity/specificity with a bivariate random-effects model and created a summary receiver-operating curve. The main analysis focused on studies reporting on a procalcitonin threshold of 0.10 ng/mL. In addition, we analysed results for all studies, studies with a 0.25-ng/mL and studies with a 0.50-ng/mL threshold. Results We included 40 of 5450 identified articles, reflecting 192 529 patients of whom 31 480 (16%) had bacteraemia. Of 40 studies, 32 had high risk of bias. The pooled sensitivity for a 0.10-ng/mL threshold was 93% (95% CI: 85–97%) with a specificity of 36% (95% CI: 26–47%). The area under the summary receiver-operating curve for all studies was 0.80 (95% CI: 0.76–0.83%; prediction interval 0.57–0.91). Discussion A low cut-off value of procalcitonin can be useful to exclude community-acquired bacteraemia, depending on what the treating clinician considers to be an acceptable trade-off between sensitivity and specificity. Procalcitonin may require combination with clinical characteristics for accurate assessment of the risk of bacteraemia and safely reducing unnecessary blood cultures.