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Diagnostic test accuracy of procalcitonin and C-reactive protein for predicting invasive and serious bacterial infections in young febrile infants: a systematic review and meta-analysis

This summary is intended to provide a snapshot of the original research. It is in no way a substitute for the original research article, nor is it intended to be a complete reflection of the original research. 

Originally published in Lancet Child and Adolescent Health, 15 March 2024

Febrile infants under 90 days face higher risks of invasive bacterial infections. Clinical guidelines, mainly using procalcitonin, can identify low-risk infants for tailored management. 
The comparative diagnostic accuracy of C-reactive protein (CRP) and procalcitonin (PCT) for predicting invasive or serious bacterial infections in febrile infants remains uncertain, despite CRP's widespread availability. This study sought to evaluate and compare the test accuracy of both biomarkers in this context.

Out of 734 studies, 14 (n=7755) were included in a meta-analysis comparing procalcitonin and C-reactive protein for detecting bacterial infections. Procalcitonin showed higher partial area under the curve (pAUC) values for invasive bacterial infections (0.72) compared to C-reactive protein (0.28), with optimal cutoffs at 0.49 ng/mL and 13.12 mg/L respectively. Both markers had similar pAUC values (0.55) for serious bacterial infections. Optimal cutoffs were 0.17 ng/mL for procalcitonin and 16.18 mg/L for C-reactive protein.

Heterogeneity varied across studies, with the absence of a standardized definition for serious bacterial infection being a major source of variability
 

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