Key result
Procalcitonin performed only moderately well as a diagnostic test for postoperative infection in major abdominal surgery (pooled sensitivity 72%, specificity 62%), whereas interleukin-6 demonstrated higher diagnostic accuracy (sensitivity 84%, specificity 76%).
Why the study?
Postoperative infection is an important cause of morbidity and mortality after major surgery, where early diagnosis improves outcomes and high-performing biomarkers could guide clinical decision making.
Do procalcitonin and interleukin-6 accurately diagnose postoperative infection or sepsis in patients undergoing major abdominal surgery?
Meta-Analysis (n=1,611)
Do procalcitonin and interleukin-6 accurately diagnose postoperative infection or sepsis in patients undergoing major abdominal surgery?
Odds Ratio: 5.8 (95% CI 3.5–9.62)
Procalcitonin performs only moderately well as a diagnostic test for postoperative infection in major abdominal surgery, whereas IL-6 demonstrates better diagnostic accuracy, though further research is needed.
IL-6 may outperform procalcitonin for postoperative infection diagnosis after major abdominal surgery; extends diagnostic meta-analyses but requires prospective validation.
Background We aim to assess the diagnostic accuracy of procalcitonin (PCT) and interleukin-6 (IL-6) as diagnostic biomarkers for postoperative infection/sepsis following major abdominal surgery. Postoperative infection is an important cause for morbidity and mortality in major surgery. Early diagnosis and antimicrobial treatment improves outcomes, and high-performing biomarkers could guide clinical decision making. Methods A systematic database search was conducted for studies reporting diagnostic performance of biomarkers (including PCT and IL-6) for infection/sepsis following major abdominal surgery. Studies were assessed for reporting of diagnostic accuracy, relevance and quality. Data were extracted for meta-analysis. Results Ten studies with 1,611 participants reported the diagnostic accuracy of PCT, with pooled sensitivity, specificity and summary receiver operator curve of 72% (95% CI 66–78), 62% (95% CI 59–64) and 0.766, respectively. Four studies with 175 participants reported the diagnostic accuracy of IL-6, with pooled sensitivity, specificity and summary receiver operator curve of 84% (95% CI 72–92), 76% (95% CI 68–84) and 0.878, respectively There was variability in the timing of sampling and cut-off values and significant heterogeneity and inconsistency between studies (I 2 diagnostic odds ratio (DOR)= 43.2% for PCT, I 2 DOR=0% for IL-6). Conclusions PCT performs only moderately well as a diagnostic test for postoperative infection/sepsis in major abdominal surgery, demonstrating limited sensitivity and specificity. Heterogeneity between studies is a limitation of the meta-analysis. There is an ongoing need for a rapid, accurate biomarker for postoperative infection or sepsis.
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Jerome et al. (2022) conducted a meta-analysis in Postoperative infection/sepsis following major abdominal surgery (n=1,611). Procalcitonin and Interleukin-6 vs. Reference standard (clinical diagnosis of infection/sepsis) was evaluated on Diagnostic accuracy (Diagnostic Odds Ratio) of procalcitonin for postoperative infection/sepsis (DOR 5.80, 95% CI 3.50-9.62). Procalcitonin performed only moderately well as a diagnostic test for postoperative infection in major abdominal surgery (pooled sensitivity 72%, specificity 62%), whereas interleukin-6 demonstrated higher diagnostic accuracy (sensitivity 84%, specificity 76%).
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