Diagnostic Value of Procalcitonin for Bacterial

Infection in Elderly Patients

A Systemic Review and Meta-analysis

S.-H. Lee, R.-C. Chan, J.-Y. Wu, H.-W. Chen, S.-S. Chang, C.-C. Lee
Int J Clin Pract. 2013;67(12):1350-1357.

Validity
1. Did the review ask a clear and focused clinical question?
Ya
Pada pasien berusia lanjut, apakah prokalsitonin dapat mendiagnosis sepsis dengan akurat?
In a elderly patients suspected with sepsis, how does procalcitonin in diagnosing sepsis?
To summarise evidence for the diagnostic accuracy of procalcitonin (PCT) tests for identifying
systemic bacterial infections in elderly patients.
2. did the review include the right type of study?
Ya
Jenis studi yang di inklusi adalah potong lintang dan kasus kontrol. Kriteria inklusi juga
mencakup studi pada manusia yang berusia lebih dari 65 tahun.
Kriteria eksklusi adalah Laporan kasus, artikel tinjauan, editorial, dan guideline. Penelitian yang
mencampur populasi dewasa dan usia lanjut juga termasuk ke dalam kriteria eksklusi.
The study types included were cross-sectional and casecontrol diagnostic test study designs,
whereas case reports, review articles, editorials and clinical guidelines were excluded. We
included studies on human subjects aged 65 years or older. We excluded mixed adult and elderly
populations.
3. Were all relevant studies identified?
Ya
Database yang digunakan adalah Medline (via PubMed) dan EMBASE. Literatur yang
digunakan berasal dari tahun 1975 hingga 2011 dan pencarian terus di follow up hingga tahun

2013. Pada PubMed pencarian dilakukan pada medical subject heading (MeSH) dan text word
keywords. Pencarian di PubMed dan EMBASE menggunakan kata kunci procalcitonin AND
(Aged OR elderly). Pencarian tidak terbatas pada tanggal publikasi, negara, dan bahasa. Apabila
terdapat data yang tidak di publikasi, penulis mengkontak peneliti untuk mendapatkan data
tersebut.
We conducted a systematic literature search for PCT and elderly people using Medline (via
PubMed) and EMBASE from 1975 to November 2011 and updated the search until March 2013.
PubMed was searched by combining two separate queries composed of the medical subject
heading (MeSH) and text word (tw) keywords. PCT has not been listed as a MeSH term yet, so
we used 'procalcitonin' as a text word without setting any language restrictions for the first
query. The second query was performed using exploded headings and independent terms for
elderly people: 'aged' [MeSH term] OR aged [tw] OR elderly [tw]. A similar search strategy and
similar search terms were used in EMBASE, employing the EMbase TREE tool (EMTREE). The
searches and studies included were not limited by publication date, country or language.
When studies were identified as containing pertinent data not included in the published article,
we contacted the authors to obtain the missing data
4. Was the validity of the included studies appraised?
Ya
Penulis menggunakan kriteria QUADAS untuk menilai kualitas dari studi yang digunakan
The quality of the selected studies was assessed using the Quality Assessment of Diagnostic
Accuracy Studies (QUADAS) criteria.
5. Were assessments of study quality reproducible?
Ya
Dalam studi ini penulis terdiri dari tiga orang, dimana apabila ditemukan ketidaksesuaian studi
dengan kriteria inklusi, maka akan diselesaikan secara konsensus dari ketiga penulis.
Any discrepancies on articles meriting inclusion between reviewers were resolved by a
consensus meeting of three authors.

6. If results were combined, was it done appropriately?

Ya
Dalam studi ini, terdapat satu studi yang dieksklusi karena memiliki subjek sehat sebagai grup
kontrol. Keadaan ini dianggap dapat menyebabkan evaluasi berlebihan dari alat diagnosis.
Hasil akhir digunakan empat studi, yang disajikan dalam forest plot.

Study by Dwolatzky et al. included healthy older home residents as the control group. We
thought this study should not be included for quantitative meta-analysis as including healthy
controls may over-evaluate the performance of the diagnostic test.
Results
1. How are the results presented and what are the main results?
Disajikan dalam kurva SROC

2. How precise are the results?

The overall sensitivity and specificity estimates for PCT tests were 0.83 (95% CI: 0.380.98)
and 0.83 (95% CI: 0.600.94), respectively. These studies reported heterogeneous sensitivity
estimates ranging from 0.24 to 0.96. The positive likelihood ratio for PCT (LR+ = 4.77; 95% CI:
2.499.13) was not sufficiently high for its use as a rule-in diagnostic tool, while its negative
likelihood ratio was acceptably low for its use as a rule-out diagnostic tool (LR = 0.20; 95%
CI: 0.040.97).
Applicability
1. Were all clinically important outcomes considered?
Ya
Prokalsitonin dapat digunakan untuk mendiagnosis sepsis, tetapi tidak superior, sehingga
dibutuhkan modalitas lain untuk mendukung hasil.
2. can results be applied to my patient care?
Ya
Spektrum pasien: berusia 70 tahun dengan kecurigaan sepsis, sesuai dengan studi. Selain itu,
biaya dan risiko prokalsitonin tidak besar sehingga dapat dipertimbangkan.