Comparison of performance characteristics of individual markers and a marker combination in predicting sepsis. Among the tested markers, PCT had the highest sensitivity (91.70%) and accuracy (80.60%) and the PDW had the highest specificity (84.70%) for predicting sepsis. The sensitivity, specificity, Youden's index (sensitivity + specificity − 1) and diagnostic accuracy of PCT, CRP, RDW, PDW, NLCR and the combination RDW + PDW + NLCR were calculated on the basis of the ROC curves and logistic regression (Table III). Receiver operating characteristic (ROC) curve analyses were conducted for the single markers and the combination RDW + PDW + NLCR in the prediction of blood culture positivity. Patients without bacterial infection were defined as those whose diagnostic investigations did not yield findings compatible with the criteria specified for bacterial infections. We collected data regarding sex, age, weight, height, underlying diseases, vital signs, presence of mechanical ventilation, medications, clinical and laboratory data for the evaluation of the sequential organ failure assessment (SOFA) score, type of surgery, complete blood count, presence of positive hemocultures including other positive isolates from other specimens, length of hospital stay, and PCT level. At least, one blood test for PCT level was performed for all patients within the first 24 hours of suspecting an infection. Serum PCT level significantly increases within the first 4–8 hours in response to bacterial infections . Guiding treatment and improving outcomes Mortality rates can reach approximately 30% for sepsis, 50% for severe sepsis and 80% for septic shock (Jawad 2012; Salvo 1995; Silva 2004). This condition can evolve to an acute organ dysfunction or tissue hypoperfusion, known as severe sepsis, or to persistent hypotension or vasopressor requirement, even after adequate fluid resuscitation, known as septic shock (Bone 2009; Dellinger 2013). C GRADE was downrated by one level for risk of bias. No study provided information about participants for whom the antimicrobial regimen was changed from a broad to a narrower spectrum. These studies were carried out in Australia, Brazil, China, Czech Republic, France, Germany, Indonesia and Switzerland. Whether antibiotic therapy should be withheld in neutropenic patients with fever and normal PCT levels, and in patients with acute pancreatitis and low PCT levels is still under discussion. If clinical symptoms indicate a possible sepsis, but the PCT level is low, sepsis therapy should be started anyway, and PCT measurements should be repeated (after 12, 24, 36 hr) until the final diagnosis is clear. Indeed, low PCT levels were related to a better outcome in patients with sepsis and infection as well as acute pancreatitis 36, 37, 38, 39. Comparison 3 PCT versus non‐PCT ‐ other outcomes of potential interest, Outcome 9 Patients on antibiotics at day 5 (survivors only). Comparison 3 PCT versus non‐PCT ‐ other outcomes of potential interest, Outcome 8 Patients on antibiotics at day 1 (among survivals). Comparison 3 PCT versus non‐PCT ‐ other outcomes of potential interest, Outcome 7 Patients on antibiotics at day 5 (non‐survivors considered as being treated with antibiotic). Comparison 3 PCT versus non‐PCT ‐ other outcomes of potential interest, Outcome 6 Patients on antibiotics at day 5 (last information carried over for non‐survivors). Comparison 3 PCT versus non‐PCT ‐ other outcomes of potential interest, Outcome 3 Mortality at 90 days. Incomplete outcome data Among the 1338 patients included in the control group, 953 (71.23%) were categorized as non-infectious SIRS and 385 (28.77%) as normal healthy volunteers. Finally, 18 studies fulfilled our eligibility criteria and were included in the final meta-analyses 17, 25–41 (Fig. 1). We checked heterogeneity of these included studies, as well as in different subgroups, to further evaluate the performance of presepsin. Subgroup analyses were conducted to compare the diagnostic accuracy and performance between these three biomarkers. Additionally, some of our included studies were direct comparisons between presepsin, PCT, and CRP. Two studies that did not show enough information about how they excluded patients was scored ‘unclear’. All studies scored ‘low’ in the domain of bias in the reference standard, since the guidelines of the ACCP/SCCM consensus conference , Sepsis-3 , SEIMC , and ABA were used to diagnose sepsis in these studies. Among the types of specimen tested for presepsin detection, six studies used whole blood, ten studies used plasma, and two studies used serum. Of the 3470 patients included in the 18 studies, 1904 (54.88%) were admitted to the emergency departments (ED), 783 (22.56%) were admitted to the ICU, and 783 (22.56%) were admitted in the ED and ICU. All trials treated control groups using published guidelines for antibiotic treatment or standard clinical practice. A high degree of heterogeneity was identified in 3 of 5 outcomes that were evaluated, and sensitivity analysis indicated that heterogeneity was decreased among studies using the same PCT-based treatment algorithm. In addition, the use of PCT-guided antibiotic therapy did not impact mortality, ICU admission, or length of hospital stay in these studies. Studies that met our criteria were prospective, randomized controlled trials involving patients with respiratory tract infections. As suggested by the results of Sun et al15 and a meta‐analysis conducted by Lu et al,19 both PCT and CRP had poor sensitivity and specificity in diagnosing infection among CKD patients with current laboratory ranges, which is consistent with our finding that both of these two indicators would elevate even if without the presence of infection. For greater detail, we next review the four largest individual RCTs done in critically ill patients of PCT antibiotic guidance, where the primary goal was antibiotic reduction. However, the authors noted these findings represented low-certainty evidence with a high risk of bias, and that decreased mortality was not found in patients with sepsis, trials with high PCT-guidance algorithm adherence, and trials that used PCT-guidance algorithms without C-reactive protein.61 For infection and sepsis, the lack of a gold standard is challenging, with the microbial etiology unknown for most cases of pneumonia, and even with septic shock, ~30–40% of such cases are culture negative.52–54 There have been several publications reporting either conceptual PCT guidance based on retrospective analysis of observational data, or actual implementation of a hospital protocol with PCT guidance. Septicemia related destruction of platelets increases production and release into the peripheral blood of larger and younger platelets10.But sometimes, it’s due to a blood disorder that makes your bone marrow produce too many platelets without a good reason.For example, PCT has diagnostic value for bacterial infections in advanced liver disease and spontaneous bacterial peritonitis (SBP).Chen J, Wang Y, Shen Z, Zhu Z, Song Y, Han R. Early diagnostic value of plasma PCT and BG assay for CRBSI after OLT.Later studies show that calcitonin is secreted after a sequential Co and post translational modification like glycosylation protiolytic cleavage, etc. .In those patients, following resolution of inflammation, PCT levels gradually decrease during the following 3–4 days.The model’s strength lies in accommodating this correlation, effectively facilitating heterogeneity investigation between studies 17, 18. Is the PCT test the only test used to diagnose and monitor bacterial infections? Furthermore, studies of PCT kinetics were more useful than studies of the unadjusted PCT level. The complicated pathological and physiological changes of elderly patients with sepsis involve changes in multiple biomarkers, as well as in multiple tissue and organ systems. PCT of 2 ng/mL indicates sepsis or septic shock.11–13 CRP values can increase over 100-fold greater than baseline values, which indicate an active state of infection. Currently, PCT level kinetics and CRP level kinetics have become the focus of research efforts for identification and assessment of disease prognosis.9,10 Under normal physiological conditions, the levels of serum PCT and CRP are very low, and are maintained at a relative equilibrium in the body. PCT has been proposed as a biomarker to early identify a septic process and to select burned patients for prompt antibiotic therapy. Early diagnosis of sepsis is crucial for the management and outcome of critically burned patients. Sixteen studies (84.2%) assessed the value of PCT level as a marker for sepsis (98-109,111,114,116,117). Most studies showed rapid kinetics of PCT levels with peak levels reached 1 day after trauma (98-106, ), and to a lesser extent on day 2 (113,114). Sensitivity, specificity, and positive/negative predictive values were also determined to assess the clinical significance of PCT test results and to evaluate threshold values for predicting sepsis based onblood culture results. PCT is detectable after infection following an increase in the levels of proinflammatory cytokines such as tumor necrosis factor-α or IL-6, with high levels maintained from 8 to 24 h, after which levels return to baseline values more rapidly than that of CRP . These findings can be useful for the treatment of critically ill sepsis patients. In this study, the utility of procalcitonin (PCT) vs. C-reactive protein (CRP) as early markers of sepsis was compared. As a result, CRP is not considered to be a useful marker in the intensive care unit (ICU) and in critically ill patients. This may lead to inappropriate treatment due to which fatal consequences have been reported. Hence, CRP concentrations can be misleading and may fail to diagnose severe sepsis 20, 21, 22. It also belongs to a different class of molecules, which may be called "hormokines," as suggested by Mueller et al. , which indicates the cytokine-like behavior of PCT during inflammation and infection. PCT has a different profile than other presently used markers of sepsis, such as C-reactive protein (CRP), lactate, or various proinflammatory cytokines (interleukin (IL)-6, IL-8). In the adult population, Desai et al. observed that surgical sepsis patients with detectable NRBCs exhibited significantly elevated mortality risks in both ICU and general ward settings. Our study addresses this need by demonstrating that NRBCs improve the diagnostic performance of traditional biomarkers. These limitations highlight the urgent need for novel biomarkers that can increase diagnostic accuracy, allow for early risk stratification, and guide personalized treatment strategies. The infection of patients with hematological diseases has the characteristics of rapid onset, rapid development and diverse types of pathogens . Bloodstream infection is a common clinical systemic infectious disease, with serious illness, rapid progress and high mortality. Characteristics of patients with single infection and polymicrobial infection Two investigators (Liu D and Su LX) independently executed the search strategy and evaluated the studies. Articles involving pediatric patients were also excluded. If multiple studies reused the same patient sample, the most recent article or the most informative article was included. In another prospective observational study, Omar et al. collected data on CRP, S–PCT, and CSF cultures every other day in 36 adult patients with severe head trauma and ventriculostomy, and observed elevated S–PCT concentration in all five patients who developed ventriculostomy-related infections. The goal of the study was to evaluate the role of S–PCT in differentiating bacterial from aseptic meningitis in patients with negative cerebrospinal fluid (CSF) examination on admission and after three days of treatment, and to assess the role of PCT and other inflammatory markers in relation to treatment efficacy. A study by Choi assessed the value of serum procalcitonin in differentiating post-operative bacterial meningitis (PBM) versus postoperative aseptic meningitis (PAM) after neurological surgery and included patients who had cerebrospinal fluid pleocytosis within 14 days of surgery. These results supported the usefulness of measuring plasma PCT levels in the differential diagnosis of CNS infections in adults. The study included 17 patients with bacterial meningoencephalitis and 16 patients with lymphocytic meningitis and showed that CSF and plasma PCT levels were significantly different between these two patient groups. In addition, PCT measurement can also be used as a tool to exclude severe systemic inflammation in patients in whom local infection or bacterial colonization is seen. For example, the updated pneumonia guideline and the sepsis guideline in Germany recommend individually adapted treatment course using PCT for diagnosis and treatment 10, 11. A review of data from 2005 to 2009 (when the PCT-guided algorithm was introduced), indicated reduction in the duration of antibiotic courses from 14 days in 2005 to 9 days in 2009 . It was found that the duration of antibiotic treatment course was 3.5 days shorter in the PCT group as compared to the control group. The study included patients treated in a neurological intensive care unit and serum levels of C-reactive protein and S–PCT were evaluated on admission day, on the day of diagnosis of SIRS or sepsis, and on days three and seven after the diagnosis. The aim of the study was to evaluate the role of serum procalcitonin levels over time during treatment for central nervous system infections. Although two patients with previous antibiotic therapy had S–PCT levels of 0.2 ng/mL as the threshold, S–PCT sensitivity and specificity approaches 100% for the diagnosis of acute bacterial meningitis . Serum procalcitonin (S–PCT) has been used as biomarker in sepsis because S–PCT levels are elevated in bacterial, parasitic, or fungal infections, while they remain normal or only slightly elevated in viral infections. In addition, the use of PCT for guidance of initiation or discontinuation of antibiotic treatment in the management of lower respiratory tract infections was approved by the United States of America (USA) Food and Drug Administration (FDA) in 2017 based on the analysis of data from the clinical trials . I have used the Sawyer Squeeze as my primary water treatment for several years.Important aspects of sepsis management are early diagnosis as well as timely and specific treatment (e.g., antibiotics) in the first few hours of triage (2).Moreover, an increase in the level of the marker may be the result of impaired glomerular filtration because PCT is excreted by the kidneys.According to Table 1, we considered the evidence to be of low quality for mortality at longest follow‐up, mortality at 28 days and mortality at ICU discharge, and of moderate quality for mortality at hospital discharge, with no significant effect of procalcitonin‐guided antimicrobial therapy, even when this approach was compared with standard care.The aim of the study was to determine the ability of several parameters used for the diagnosis of acute meningitis in differentiating between bacterial and viral meningitis in adult patients with a negative CSF examination.The combined detection of these three markers provides the highest diagnostic efficiency and helps in the early clinical differential diagnosis of pneumonia infection types (Ma et al., 2023).Serial measures of PCT, in children with low-risk febrile neutropenia receiving chemotherapy, may help reduce the duration of antibiotics .We downgraded the evidence from high to low quality because risk of bias from primary studies was downgraded by two levels. Sepsis remains one of the principal threats in critically ill children admitted to the pediatric intensive care unit (PICU) where timely and appropriate antimicrobial therapy is the standard of care to optimize health outcomes . Chen J, Wang Y, Shen Z, Zhu Z, Song Y, Han R. Early diagnostic value of plasma PCT and BG assay for CRBSI after OLT. 细胞群的平均表达量的方式：total sum scaling (TSS) normalizationThe expm1 does un-log the data, but the normalization persists (this would be lost in the counts slot)expm1() transformed in order to recover normalized values not in log scale在网上也请教过一个大佬，以下是他的答复，非常感谢迷茫时有人点灯 Rain gear & cold weather gear One‐way ANOVA of PCT and CRP levels between different RRTs among stage 5 CKD patients In order to investigate whether RRT including hemodialysis and peritoneal dialysis can have an impact on PCT and CRP levels among stage 5 CKD patients or not, we conducted the one‐way ANOVA in these two parameters as well. No significant difference was found in PCT levels between patients with stage 3 and 4 CKD. We also observed significant elevations in BUN, CREA, CysC, K, and CRP levels in CKD patients, while the Na, Cl, and Ca levels were significantly decreased compared to the levels in healthy controls (P P 2 was consistent with the pathology of CKD, suggesting the high quality of our assay. In order to exclude the existence of infection, all potential study participants were subjected to blood culture before enrollment, and only those who have a negative result were selected. 21. Analysis. Thus, bleeding is a frequently occurring complication in a low platelet count as platelets play a vital role in primary hemostasis and it may be the cause of death in thrombocytopenic patients.2,3 In the present study, platelet indices such as MPV, PCT, and PDW are higher in the hyper-destructive group and may discriminate hyper-destructive from hypo-productive causes of thrombocytopenia. An observational, prospective, and comparative study was conducted on 134 patients with thrombocytopenia, and 67 cases were taken as the normal group. Svoboda 2007 published data only P.T., E.E.T, J.H., A.R., C.R.G, S.L.W. participated in the study design; in the collection, analysis, and interpretation of data; in the writing and critical revised the manuscript.Currently there is no recognised diagnostic test available for sepsis diagnosis as stated by the Sepsis-3 task force .In addition, continuing re-evaluation during the course of sepsis is advisable.Similarly, in another study, heart failure can cause elevated PCT levels and can be indicative of a worse prognosis.The Stop Antibiotics on Procalcitonin guidance Study (SAPS) looked at the algorithm to stop antibiotics only.36 The study was conducted in a health care setting of a comparatively low use of antibiotics.Articles from Infection & Chemotherapy are provided here courtesy of Korean Society of Infectious DiseasesExclusion criteria included patients with malignant tumors, immune deficiencies, or those who did not complete follow-up. Further prospective studies are needed to confirm these findings. This is the first study where these parameters have been examined as a ratio. We found on multiple regression analysis that the ratio of MPV/PCT, PDW/Platelet count and MPV/Platelet count were predictors of mortality with the Odds ratio of 4.31, 3.86 and 3.45 respectively. This could have resulted from an increase in the production of platelets and the release of immature and larger platelets into the circulation to meet the increase demands. We found that the ratio of MPV/PCT was a better predictor of mortality than platelet count or plateletcrit by themselves. The Stop Antibiotics on Procalcitonin guidance Study (SAPS) looked at the algorithm to stop antibiotics only.36 The study was conducted in a health care setting of a comparatively low use of antibiotics. The PCT guided strategy reduced the duration of antibiotic usage to 5 days compared with 7 days in the standard-of-care group. Exposure to antibiotics was reduced by approximately one third in all diagnostic groups. Notably, the diagnostic performance of CRP and PCT, as evidenced by their respective AUCs of 0.78 and 0.82, confirms that PCT is slightly more reliable than CRP in diagnosing sepsis, a finding that has been consistently reported in recent studies 10,14. The elevated mean CRP (102.3 mg/L) and PCT (5.4 ng/mL) levels in this cohort are in line with previous reports that have highlighted the role of these biomarkers in sepsis. The findings of this study align with and build upon previous research on the prognostic significance of CRP, PCT, and other clinical markers in sepsis. These trends suggest that patients in the CRP group experience a higher rate of adverse events compared to those in the PCT group, emphasizing the potential prognostic value of CRP levels in predicting patient outcomes. The diagnostic precision of CRP and PCT in detecting early sepsis was evaluated by the receiver operating characteristic (ROC) curve analysis, and the area under the curve (AUC) was computed for each biomarker. In this study, S–PCT had a 95% sensitivity, 100% specificity, and 100% negative predictive value, as well as a 97% positive predictive value for distinguishing BM versus Viral Meningitis (VM) when using a diagnostic cut-off level of 0.28 ng/mL (AUC, 0.99; 95% CI, 0.99 to 1) . A prospective study from the Saint-Etienne University Hospital in France collected data from all patients admitted to the emergency unit with suspected meningitis between 1997 and 2009. In addition, in matched serum samples, S–PCT levels were elevated in meningitis patients, but not in dementia patients . Managing Your Health If the water was really cold, I would wait an hour for treatment, which meant that I would carry extra water so that I wasn’t refilling only when I was totally out. The biggest downside to chemical treatment to me was the wait time. I made do with the stubby spork for several days until I got to Bishop, where I picked up a Vargo Titanium Eagle Spork. Quality assessment of the included studies. Based on the above observations, serum PCT level measurement is recommended for the guidance of antibiotic therapy . Recent studies shows that soluble cluster of differentiation 14 (sCD14) plays a significant role as biomarker with respect to diagnosis of sepsis. Univariate analysis shows higher PCT and CRP level and higher positive blood culture rate during septic shock. Platelet count, PCT, CRP, creatinine, erythrocyte sedimentation rate (ESR), albumin and white blood cells (WBC) were measured at the time of admission to the emergency department before administrating antibiotic treatment. Through education-based antibiotic stewardship, which includes also the use of PCT measurements, a reduction of antibiotic prescriptions and lower resistance rates could be achieved. In order to gain more confidence with PCT measurements, repeated education for antibiotic stewardship could be advantageous for physicians. The interventional non-inferiority proACT trial revealed low adherence rates to the PCT protocol, indicating a shortcoming of experience in the use of PCT as well as in its interpretation in a clinical context. A more widespread use of PCT in critically ill patients was limited by the fact, that a commonly accepted algorithm for the utilization of PCT in those patients was long lacking (21). Analytical evaluation of the performances of Diazyme and BRAHMS procalcitonin applied to Roche Cobas in comparison with BRAHMS PCT-sensitive Kryptor. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes［J］. More recently, two controlled trials evaluating efficacy of a PCT-based algorithm to reduce antibiotic therapy duration showed diverging results. Further data to confirm the clinical utility of PCT cutoffs after pediatric cardiac arrest is required. Serial measures of PCT, in children with low-risk febrile neutropenia receiving chemotherapy, may help reduce the duration of antibiotics . In this setting, a higher rate of false negative PCT measurements can be expected, and physicians must systematically investigate possible local infections. In contrast, elevated PCT above 0.25 µg/L is common among children requiring non-invasive or invasive mechanical ventilation due to viral illnesses (e.g., bronchiolitis) , making it less useful in confirming that an infection is bacterial. Acute appendicitis and platelet parameters For clinical utility evaluation, we assumed a pre-test probability of 52.9% (i.e., median value of prevalence of included studies). Hierarchical summary receiver operating characteristic plot of procalcitonin across all included studies Forest plots of the sensitivity and specificity for procalcitonin across all included studies Consistent with many meta-analyses of diagnostic accuracy studies, we observed substantial heterogeneity among the included studies. Regarding applicability, two studies displayed a high risk in the patient selection domain as they enrolled not only non-neutropenic patients but also those with neutropenia 19, 25. Statistical tests used for handling the data were chi-square test for categorical variable, independent t-test for mean and comparison, and Pearson correlation coefficient to correlate various platelet and hematological indices with biochemical parameters. In addition, demographic information such as age, sex, diabetic duration, family history, the patients' clinical complications, smoking, dietary habits, and exercise are noted from the hospital records. The study consists of 200 patients reported with type 2 DM with complications and without complications. All the patients who met the inclusion criteria and provided the written consent are selected for the research analysis. Specifically for the pediatric population, PCT is a moderately helpful diagnostic test, except for the diagnosis of meningococcal disease, where it may be highly accurate. No case–control studies or randomized controlled trials were included. Table 1 presents the characteristics of the included studies. The search in the reference lists of the identified articles did not return any more eligible studies. When the pooled study number was less than four in subgroup analyses and beyond STATA’s processing capability, summary estimates were obtained with R version 4.1.2 (R Foundation for Statistical Computing, Vienna, Austria). It would be advisable to measure PCT in the diagnostic phase of sepsis, to have an initial baseline PCT value, before antibiotics are administered . Currently there is no recognised diagnostic test available for sepsis diagnosis as stated by the Sepsis-3 task force . The higher the level of PCT, the greater the likelihood of systemic infection and sepsis . No, PCT test is not the only test used to diagnose and monitor bacterial infections. Procalcitonin (PCT) is a protein that is produced by the body in response to bacterial infections. The major complications of acute pancreatitis are infected pancreatic necrosis, sepsis, and multi-organ failure. Multiple scoring systems, including the Ranson, Glasgow, and APACHE II scores, and several biochemical markers have been developed for the early prediction of severity of acute pancreatitis which facilitates early treatment in an intensive care unit. The study showed a significant correlation between PCT concentration, CRP and WBC count. Infection reported included pneumonia (70%), intra-abdominal infection (18%) and bacteremia (5%). However, the signs and symptoms inherent to the infection are often missing or are difficult to identify in these subjects. Is mean platelet volume a new predictor in confirming a diagnosis of acute appendicitis? Mean platelet volume and platelet distribution width as markers in the diagnosis of acute gangrenous appendicitis. Evaluation of mean platelet volume as a diagnostic biomarker in acute appendicitis. Tanrikulu CS, Tanrikulu Y, Sabuncuoglu MZ, Karamercan MA, Akkapulu N, Coskun F. Mean platelet volume and red cell distribution width as a diagnostic marker in acute appendicitis. Mean platelet volume as an indicator of disease severity in patients with acute pancreatitis. Two reviewers (Y.-C. L. and H.-T. Y.) independently screened all studies by title and abstract using EndNote 20 (Clarivate Analytics, Philadelphia, PA). Data extraction and assessment of the methodological quality of the included studies were also conducted in line with the outlined guidelines. Subsequently, each study underwent a comprehensive review based on predefined eligibility criteria, with the inclusion of a meticulous evaluation using the PRISMA-DTA checklist. Therefore, we herein systematically examined the diagnostic accuracy of PCT and compared it with C-reactive protein (CRP) in this population. The results of other randomized controlled trials that evaluated the use of PCT in critically ill patients were analyzed in meta-analyses.If you take 25mg for 8 weeks or less you do not need a pct for ostarine.The first study by Stolz et al. (33) enrolled patients with COPD, that by Christ-Crain et al. (8) enrolled patients with CAP, and those by Briel et al. (5) and Burkhardt et al. (6) included patients with either upper or lower acute respiratory tract infections.PCT secretion is stimulated in bacterial infections by various cytokines, such as IL–1, IL–6, and tumor necrosis factor-alpha.Evaluation tests for treatment monitoring and prognosis estimation should be considered.While platelet count and plateletcrit (PCT) didn't differ significantly between groups, individuals with hyperdestructive thrombocytopenia had higher MPV values.Procalcitonin increases can be seen 2–4 hours after bacterial induction, rise rapidly and reach a plateau after 6–12 hours.Diagnostic criteria can be established for different infection states in patients with hematological diseases, such as bacteremia, sepsis, etc. Positive cultures were Gram-stained, and subcultured on solid media for subsequent analysis. Blood samples were extracted from peripheral venous puncture of the patients, directly injected into Bactec bottles, and incubated in a Bactec incubator (BD Diagnostics, Franklin Lakes, NJ, USA). Patients with a positive blood culture constituted the positive group and those with a negative blood culture were classified into the negative group. Recently, an investigation by Loonen et al (1) demonstrated that NLCR was a rapidly available biomarker, which appeared most promising in differentiating patients with BSI from those without BSI for subsequent pathogen identification (1). A cut-off of 0.1–0.5 ng/mL or a reduction of more than 80% from baseline is commonly utilized for decision-making on antibiotics.7Flowchart 1 provides a consensus overview of the utility of serum PCT for the rational use of antibiotics in admitted patients with infections. If induced, serum PCT levels increase 6–12 hours after infection; PCT levels decline over 24 hours with optimal therapy. Procalcitonin has been used for the diagnosis of infections among patients with cirrhosis/end-stage liver disease. Procalcitonin has been used to differentiate urosepsis and bacteremia among patients with urinary tract infections (UTIs), however, the sensitivity and specificity remain variable. Serial PCT levels have been used in antibiotic de-escalation and antibiotic stewardship studies. A total of 1,949 patients fulfilled the inclusion criteria and were enrolled in the study. PCT was not drawn concomitantly with the first BCs in 1,702 patients that were excluded from the study. During the entire study period, a total of 8,752 BCs were collected from 3,651 patients. Coagulase-negative staphylococci, Corynebacterium spp., and other skin commensals were considered contaminants when isolated from only one set of BCs and in the absence of clinical and/or laboratory data suggesting their pathogenic role. Early treatment of sepsis is most effective ("the golden hours of treatment"), and complications like organ dysfunction indicate an already progressed state of the disease. The lag time for PCT induction is approximately 2 to 4 hr after the onset of sepsis, a time period that has usually passed if patients are presented at the emergency department (ED). This individualized approach has been evaluated in various studies, and it is recommended to be a part of an antibiotic stewardship program. Procalcitonin (PCT) is used as a biomarker for the diagnosis of sepsis, severe sepsis and septic shock. Aktimur R, Cetinkunar S, Yildirim K, Aktimur SH, Ugurlucan MH, Ozlem N. Neutrophil-to-lymphocyte ratio as a diagnostic biomarker for the diagnosis of acute mesenteric ischemia. When added to standard clinical care, one study showed that early measurement of PCT can help to identify children admitted to the PICU with signs and symptoms of potential infection who are at low risk of bacterial infection . Given the higher risk of severe outcomes from infections in immunocompromised children and insufficient data on the use of PCT in these patients, guidance should consider whether to include this population in the recommendations. The American Thoracic Society (ATS) guideline for CAP recommend that PCT levels be used to distinguish upper from lower respiratory tract infections in adults . This study found LUS combined with PCT levels to be more sensitive and specific for diagnosing bacterial pneumonia (sensitivity was 90% and specificity was 85%) compared to LUS or CXR alone, and CXR combined with PCT levels. If the CXR or LUS did not suggest a bacterial pneumonia, but PCT levels were higher than 1.0 µg/L, antibiotics were also recommended. First, because of the retrospective nature of these studies, the interval between symptom onset and blood testing was not reported in these studies.They have the same precipitants, symptoms, and treatment.Haselwanter was able to prove that the PCT level was elevated in patients with acute-on-chronic liver failure (ACLF).When doing differential expression, you generally ignore genes with low expression.In single cell datasets, there are many genes like this.We have not observed any statistically significant difference in the mean value of both the platelets and the RBCs parameters between the groups before considering the gender of the participants (Table 3).Thus, higher‐quality evidence will certainly be achieved if researchers concentrate their efforts on analysis of common and clinically relevant outcomes.Indeed, low PCT levels were related to a better outcome in patients with sepsis and infection as well as acute pancreatitis 36, 37, 38, 39.Depending on the success of therapy, high PCT levels are more frequently related to an increased mortality risk. Procalcitonin was increased in 22.8% of patients with the severe course, and 30.6% with adverse outcomes, implying low sensitivity for severity and outcomes. Procalcitonin is a promising biomarker to limit antimicrobial usage in patients with suspected LRTIs. As the half-life is 20–24 hours, most trials assessing its utility in sepsis have tested PCT daily or every 48 hours. There is an urgent need for accurate biomarkers to diagnose or exclude suspected sepsis from non-infective causes. Biomarkers can have a supportive role in identifying specific physiopathological pathways in sepsis. The main characteristics and data of each included study are summarized in Tables 1 and 2. Flow chart of study identification, inclusion, and exclusion for meta-analysis Our search in electronic databases yielded 86 published studies, 62 of which were excluded for various reasons based on screening the titles and abstracts (Fig. 1), leaving 24 studies that were assessed for full-text review. Immunocompromised patients have an increased incidence of severe and life-threatening infections. Procalcitonin should be used as a part of an antibiotic stewardship program for antibiotic de-escalation in patients with VAP on antibiotics beyond 7 days (1A). Baseline PCT levels have varied sensitivity in differentiating bacterial and viral CAP. Baseline PCT levels have not been consistently shown to reduce antibiotic exposure in community-acquired LRTIs. PCT is the value that indicates the rate at which infection or sepsis spreads in the bloodstream. In these two situations, where the body’s defense cells are intensely activated, procalcitonin levels typically peak between the second and fourth hours. It is an important indicator in cases of bacterial infection and the development of sepsis. The Procalcitonin test, known as PCT, is used to measure the level of procalcitonin in the blood. We now plot the three QC covariates n_genes_by_counts, total_counts and pct_counts_mt per sample to assess how well the respective cells were captured. For mouse datasets, the prefix is usually lower case, so “mt-“. As mentioned, the dataset used in this notebook is human bone marrow, so mitochondrial counts are annotated with the prefix “MT-”. Fifty-nine patients met the criteria for inclusion in this study. Adult patients selected for this study were hospitalized in the ICU of the Affiliated Hospital of Hebei University during the period from March 2016 to July 2018. For example, according to the specificity of the biochemical indicators to determine the severity of infection, timely control of infection can be achieved through effective antibiotics or surgery to reverse the progress of the disease; clinicians can also monitor changes in disease. Rapid and accurate disease diagnosis, as well as timely medical intervention, can help clinicians confirm the disease in an appropriate timeframe and make necessary treatment decisions. They simultaneously measured PCT and CRP in 73 medico surgical ICU patients; according to the American College of Chest Physician (ACCP) criteria-based study group, 75% cases revealed SIRS in clinical representation. Based on receiver operating characteristic (ROC) curve analysis, they concluded that PCT is the most reliable marker for the diagnosis of sepsis, with 89% of sensitivity and 94% of specificity . Muller et al. conducted a study in patients with community-acquired pneumonia; the serum PCT concentration could differentiate bacterial from viral causes. Therefore, identifying a potential combination of biomarkers to improve the early diagnosis of sepsis is imperative. According to the Global Burden of Disease (GBD) study, approximately 25 million sepsis cases occur annually in pediatric and neonatal populations, resulting in approximately 3 million deaths (Watson et al., 2024). Treatment and clinical outcomes in children with sepsis. Power analysis has not been performed in any of these studies. Inactivated platelets in the blood are discoid shaped and do not contain a nucleus. In this group of patients, its diagnostic thresholds and effectiveness need to be reconsidered. It goes without saying that the PCT result should be used in conjunction with clinical evaluation of the patient and not on its own.A similar randomized trial that enrolled 337 children with lower respiratory tract infections allocated antibiotics either according to a PCT guided algorithm or usual care .In particular, their results indicated that positive blood PCT could confirm a diagnosis of BM, while negative blood PCT alone is sufficient to rule out it.In this retrospective study, we analyzed serum PCT in hematological patients with bloodstream infection are generally low.The authors concluded that PCT guided antibiotic therapy may reduce antibiotic exposure without increased adverse outcomes in LRTIs.Investigation on reference intervals and regional differences of platelet indices in healthy Chinese Han adults. Search methods for identification of studies Figure 3 shows the IMD level on the 20-m band with PureSignal turned off, while Figure 4 shows the level with PureSignal turned on.The above cases should be considered on a case-by-case basis, especially when a surgical operation may be accompanied by an infection.Whilst algorithms for PCT guided antibiotic therapy have been proved to be useful in reducing duration of antibiotic therapy in several RCT in different clinical settings, very limited testing has been done for CRP-based algorithms in RCTs.The present study used only a single PCT level on admission to the ED, and the correlation with the outcomes may be suboptimal.In this study, the ROC curve analysis revealed that plasma CRP level exhibited the poorest diagnostic performance, with low specificity in the early diagnosis of sepsis in children.This study was funded by Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.Procalcitonin levels may be repeated every 72 hours or earlier if clinically indicated (3B).We used a systematic and sensitive search strategy with search terms for sepsis, severe sepsis, septic shock, procalcitonin evaluation and randomized controlled trials (Appendix 2).From a clinical point of view, biomarkers should be able to complement the clinical judgement and interpretation of available prognostic and diagnostic tests, in order to improve patients care. The treatment of sepsis and septic shock followed the guidelines established by the International Consensus Conference on Pediatric Sepsis . WBC, white blood cell; PLT, platelet; CRP, c-reactive protein. Blood index for septic children with and without nucleated red blood cells (NRBCs) before and after treatment. Demographic characteristics in children with bacterial sepsis. A diagnosis of septic shock required (1) the presence of age-specific SIRS criteria (≥2 items); (2) confirmed or suspected invasive infection; and (3) objective evidence of cardiovascular dysfunction. Male predominance in our study was similar to that in other studies; on the other hand, because of uneven distribution of sex among the study group, females were predominant;15,18 however, males were predominant in the hypo-productive group. Therefore, platelet indices can be used to categorize the cause of the thrombocytopenia so that the treatment is started at the earliest. The complete blood counts generated by automated analyzer values for platelet indices are also given along with the platelet counts. Platelet indices were analyzed under various clinical conditions Table 4, and it was observed that the platelet count was lower in acute leukemia, whereas it was higher in the hypo-cellular marrow. To the best of our knowledge, this is the first study showing a significant difference in the PCT values between bloodstream infections sustained by Enterobacteriaceae and those caused by nonfermentative Gram-negatives. The main findings of this study are that, in patients with suspected sepsis, the PCT cut-off value of 10.8 ng/mL could be of help in predicting an infection caused by Gram-negatives, with a specificity of 82.5%. PCT values corresponding to pathogens isolated from single patients with monomicrobial or polymicrobial bloodstream infections. First, the study population was drawn from a single center, resulting in a relatively small sample size, which may limit the generalizability of our findings. This study has several limitations. These biochemical mediators stimulate the maturation of immature red blood cells in the bone marrow, leading to the appearance of NRBCs in the circulation. Previous work from our group identified NRBC positivity as an independent risk factor for disease severity and mortality in pediatric sepsis (Li et al., 2023). Early recognition and differentiation of sepsis and septic shock are critical for initiating timely and appropriate management. The early detection of procalcitonin (PCT) is crucial for diagnosing bacterial infections due to its high sensitivity and specificity. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Different studies have evaluated the prognostic potential of PCT in patients with respiratory infections, mainly in patients with CAP, the greatest benefit of PCT was found in patients classified as high risk by the pneumonia severity index score. Another study focused on the potential of PCT to differentiate patients with a viral respiratory infection with or without bacterial super infection. The evolution of PCT as a marker of sepsis is similar to the evolution of biomarkers of other disease processes. Furthermore, due to the observational character of the study, it is not possible to demonstrate a causal relationship between biomarkers and outcomes. This study is subject to limitations, such as its relatively small sample size and single-center design, which may restrict the applicability of the results. This is particularly relevant given the ongoing debate regarding the most effective biomarkers for early sepsis detection. A strong correlation was found between the Sequential Organ Failure Assessment (SOFA) score and mortality in both sepsis and septic shock groups. Serum PCT and CRP have good clinical diagnostic and prognostic value for patients with sepsis and septic shock. Regarding changes in serum PCT level in each group, the levels of PCT were significantly different between non-survivor and survivor groups, whereas they did not differ between patients in the sepsis and septic shock groups. On the 2nd, 3rd, and 5th days, the CRP level was higher in the non-survivor group than in the survivor group, and the serum CRP level was higher in patients in the septic shock group than in patients in the sepsis group. Qu et al.3 have discovered a positive correlation between serum PCT and serum total bilirubin (TBIL) level and suggested the diagnostic threshold should be adjusted according to the stages of liver function. PCT is also an unsatisfactory biomarker for sepsis during the early phase following liver transplantation, whilst IL-6 performs much better for detecting postoperative bacterial sepsis.47 Lin et al.44 claimed that, among cirrhotic patients, the diagnostic value of PCT is lower than IL-6 (for an IL-6 cut-off value of ≥135 pg/mL). When combined with other biomarkers for infection, PCT can help make a more accurate diagnosis. At the same time, this diagnostic approach, as well as in research that is related to the infection of lower respiratory tract (22) resulted in a lower number of taken blood cultures for 40%, by which each examinee could save $ 36, while maintaining the percentage of detection bacteremia for 94-99%. Manifest urinary tract infections of adults in 20% of cases are complicated bacteremia, which prolongs hospital treatment and increases the risk of fatal outcome from 0.3% to 7.5-30%. The authors concluded that the increase of serum procalcitonin is an important diagnostic marker in identifying and predicting the outcome of VAP, and its usefulness is confirmed by the result of many other studies (23, 24, 25). PCT showed the highest diagnostic accuracy in predicting bacteremia (AUC 0.82, 95% CI, 0.78 to 0.87) in relation to other compared laboratory and clinical markers (L, urea, CRP, temperature, systolic blood pressure, pulse, renal dysfunction). In addition to that, we failed to observe a significant reduction on PCT among stage 5 CKD patients between RRT and non‐dialysis, which are different with previous knowledge that dialysis can reduce the PCT level.18 Our results may be caused by insufficient number of study participants who did not receive RRT and should be interpreted cautiously. As can be seen, the present study recruited 289 patients in CKD stage 5, and the PCT level in those patients was significantly higher than patients in stages 3 and 4. If patients are not properly sterilized, hemodialysis can be a vector for transmitting various infectious diseases, for instance, hepatitis C,17 and the infection can further worsen the patient's diagnosis. The objectives of the present study are to study the variation and effectiveness of platelet indices in establishing the etiology of thrombocytopenia. PCT is considered a specific biomarker for bacterial infection and has several benefits. The results showed no significant difference between duration of antibiotic use between the PCT (8.1 days) and CRP (7.2 days) groups. A combination of a low CRP and a low PCT suggested that pneumonia was unlikely to be caused by mixed bacterial infection. This study further analyzed the statistically significant differences in microbial composition between the Control and SP groups.PCT measurement aids in the diagnosis of sepsis and to guide and monitor antibiotic therapy.Taking blood from some people may be more difficult than from others.In another systematic review, the authors concluded that PCT levels in early stages of sepsis are significantly lower among the survivors compared with nonsurvivors of sepsis.PCT is detectable after infection following an increase in the levels of proinflammatory cytokines such as tumor necrosis factor-α or IL-6, with high levels maintained from 8 to 24 h, after which levels return to baseline values more rapidly than that of CRP .In a meta-analysis, Schuetz et al. reviewed data of 4,221 patients who have been investigated in 14 trials. Furthermore, the optimal cutoff values may vary across different age groups of patients. But, Senmin Chen et al. have shown that the PCT level of neutropenia is significantly lower than the BSI of non-neutropenia, and the area under the ROC curve (AUROC) of PCT was 0.68 . The young age of the patients infected with gram-positive bacteria may be related to the difference in the distribution of adult and childhood flora (Table 4). Incorporating these parameters into the diagnostic workup of thrombocytopenia can provide a more comprehensive assessment of platelet status, aiding in the differentiation of underlying etiologies and risk stratification. For instance, patients with mild thrombocytopenia may exhibit bleeding tendencies disproportionate to their platelet count, while others with severe thrombocytopenia may remain asymptomatic. Current diagnostic challenges in thrombocytopenia revolve around the limitations of conventional methods that predominantly focus on platelet count alone. Specific indications like treatment of endocarditis or severe bone infection are excluded from this rule. This algorithm involves both criteria of absolute PCT cut-off values and a kinetic algorithm, for either initiation or termination of antibiotic therapy (Fig. 1). Further, only periods of invasive bacterial infection should be treated, rather than colonization or local superinfection. Meanwhile, as a guide for antibiotic therapy, PCT is also mentioned in various guidelines 10, 11. A selection of conditions where PCT is induced independent of sepsis and infection are indicated in Table 1. After we had extracted all estimates of effects from the primary studies, we had an excess of 56 dependent variables on which to base our comparisons between procalcitonin and non‐procalcitonin groups (standard care or CRP), as shown in Analysis 3.1 to Analysis 3.38. Four trials reported directions of effect favouring the procalcitonin groups, with differences between median values ranging from a half‐day to two days, but only Nobre 2008 found a statistically significant difference (0.03) between the procalcitonin group (median of 3 days; IQR 1 to 18) and the non‐procalcitonin group (median of 5 days; IQR 1 to 30). With the exception of Oliveira 2013, other trials (Annane 2013; Deliberato 2013; Nobre 2008; Shehabi 2014) showed results favouring the procalcitonin groups, with differences in median values ranging from two days to seven days, but found no statistical significance (Analysis 2.1). We downgraded the evidence from high to very low quality because risk of bias was downgraded by one level, imprecision by one level and inconsistency by two levels. We downgraded the evidence from high to moderate quality because risk of bias and imprecision from primary studies were downgraded by one level. After that post cycle therapy is needed for 4 weeks straight. The best sarms for pct are ostarine, cardarine, and mk 677. The best pct will change, depending on if you’re doing a sarms stack,. Home ‘ legal steroids ‘ 8 best legal steroids pills for muscle growth, strength, and power, ostarine pct. The analysis of retrospective data from two independent US critical care institutions indicated a high prognostic power for the 72-hour PCT kinetics for predicting sepsis mortality (50). Trauma, pregnancy, high volume transfusion, malaria; PCT-guided stewardship should not be applied to patients with chronic infections (e.g., abscess, osteomyelitis, endocarditis). A meta-analysis conducted by Tang et al. in 2007, included 18 studies with 2,097 critically ill patients and showed a median sensitivity and specificity of 74% for PCT. We eliminated 1,963 articles for various reasons based on the title and abstract, leaving 135 studies to scrutinize with a full text review. We also constructed a summary receiver operator characteristic (SROC) curve by plotting the individual and summary points of SEN and SPE to assess the overall diagnostic accuracy . If no threshold effect existed, a bivariate random effects regression model 21–22 was used to calculate the pooled SEN, SPE, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), and negative likelihood ratio (NLR). Most researchers recommend measuring PIs within one hour regardless of anticoagulant, which is not indicated in most of the studies (88). The present review has limitations that come from the limitations of the included studies. WBC and MPV values were higher in the acute mesenteric ischemia group than the control group with a normal appendix which were operated according to wrong pre-diagnosis as an acute appendicitis. In contrast, Aktimur et al. stated that MPV demonstrated significant prognostic difference in surviving patients with acute mesenteric ischemia. The ready availability of this parameter at no additional cost may encourage its utilization in clinical practice (82). We performed additional post hoc sensitivity analyses to test the effects of including three studies with inclusion criteria not specific for sepsis, severe sepsis or septic shock, as previously planned in our protocol (Bouadma 2010; Jensen 2011; Layios 2012) and as shown in Sensitivity analyses 2, 3 and 4 below. We performed a sensitivity analysis to observe the effects of imputing missing data with poor outcomes in the analysis of our primary outcome of "Mortality at longest follow‐up" (Higgins 2011). Comparison 3 PCT versus non‐PCT ‐ other outcomes of potential interest, Outcome 41 Cost reduction for antibiotic treatment. Comparison 3 PCT versus non‐PCT ‐ other outcomes of potential interest, Outcome 23 Antibiotic therapy‐free days (mean, SD) ‐ PCT vs standard care. The structure of the search in the “Search details” window of the PubMed website was (procalcitonin Title/Abstract OR “calcitonin” MeSH Terms) AND (meningitis Title/Abstract OR “meningitis” MeSH Terms). To identify relevant publications of interest, we conducted a PubMed search on 24 May 2018 using the terms ‘procalcitonin and meningitis’ as “Title/Abstract” or as “MeSH Terms”. Procalcitonin (PCT) and C-reactive Protein (CRP) are the biomarkers most commonly used, but have a limited ability to distinguish sepsis from other inflammatory and non-inflammatory states or to predict outcomes. The term “biomarker”, as used in daily clinical practice, refers to molecules and biological products used as markers for the assessment of disease progression or as indicators for the presence of an abnormal clinical state. In the control group, the risk was significantly higher in the colonized patients than in the non-colonized patients. Four studies 24, 29, 33, 35 excluded patients with comorbidities potentially linked to PCT levels, such as end-organ damage and autoimmune diseases. All studies included a representative sample of patients who underwent PCT testing in practice and clearly described the diagnostic criteria for sepsis. We tabulated TP, FP, FN, and TN rates based on the effect of single PCT levels or PCT non-clearance on all-cause mortality in sepsis patients. During systemic bacterial infections, expression of the calcitonin 1 gene (CALC-1) is upregulated in nearly all tissues in response to elevated levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-1β. In contrast, in some cases, PCT levels can be low and remain low despite the presence of infection requiring antibiotic therapy . In addition, adult studies including severely ill patients have showed that PCT-guided therapy leads to a decrease of antibiotic exposure without compromising infection cure and patient safety. Tang et al performed a meta-analysis to estimate the accuracy of PCT to diagnose sepsis in critically ill adult patients.53 The pooled results of 14 phase II diagnostic studies (i.e., studies evaluating the discriminatory ability of a test) showed positive and negative likelihood ratios of 3.03 (95% CI, 2.51–3.65) and 0.43 (95% CI, 0.37–0.48), respectively, and an area under the receiver operating characteristics curve (AUC ROC) of 0.73 (95% CI, 0.69–0.77). PCT has been proposed as a biomarker capable of discriminating between bacterial infections and other inflammatory processes (including viral infection) based on the significantly higher increase in its levels in the presence of bacterial stimulus. The higher levels of PCT in patients with severe bacterial infections than those of PCT in patients with mild bacterial or viral infections were noted . Furthermore, the first description of elevated levels of PCT in patients with bacterial infections was described in 1993 . Respectable number of randomized controlled trials confirmed that treating lower respiratory tract infections and sepsis, according to the PCT antibiotic stewardship, reduces antibiotic exposure, without compromising safety of patients and the treatment outcome. Median C-reactive protein (CRP) and procalcitonin (PCT) concentrations in bacteremic patients, nonbacteremic patients, noninfected patients, systemic inflammatory response syndrome (SIRS) patients, sepsis patients, and septic shock patients. The median PCT levels were 0.50 ng/ml in noninfected patients without SIRS, 0.47 ng/ml in noninfected patients with SIRS, 0.67 ng/ml in septic patients, and 3.13 ng/ml in septic shock patients. There was no relationship between the serum CRP and PCT levels and the type of infecting bacteria (data not shown). PCT median values corresponding to pathogens that were isolated from two or more patients with monomicrobial bloodstream infections. It is produced in response to bacterial endotoxin and inflammatory host cytokines and may help in discriminating bacterial from viral infections and true bacteremia from contaminated blood cultures 5, 6. This study suggests that PCT may be of value to distinguish Gram-negative from Gram-positive and fungal bloodstream infections. Twelve articles met our inclusion criteria but were generated from 10 studies. Visual inspection of the funnel plot (Figure 5) revealed no apparent influence (tendency) of small studies leading to more or less beneficial intervention effect estimates (Higgins 2011). Comparison 3 PCT versus non‐PCT ‐ other outcomes of potential interest, Outcome 40 Mean cost with antibiotics + PCT kit per participant (USD). According to the cut-off value, patients were divided into high PCT group and low PCT group, high RDW group and low RDW group. A total of 205 patients with severe burns who were treated in the First Affiliated Hospital of Anhui Medical University from November 2017 to November 2022 were retrospectively analysed. However, the future role of APRs will likely continue as an important adjunct to comprehensive clinical assessment. We did this preliminary case control study to test this hypothesis. Becchi et al noted that MPV at an early stage of sepsis was important prognostically16. Canine models of endotoxemia have shown that the platelet count and PCT decreased where as MPV and PDW are increased showing that platelet counts are correlated positively with PCT, but correlate negatively with MPV and PDW during early endotoxemia in dogs14. Following its discovery, there have been a substantial number of clinical studies conducted to evaluate the presence of bacterial infections, and to guide antibiotic treatment by the stratified levels of PCT. The objectives of this study were to determine if PCT levels increase in VL patients, whether there is any correlation between PCT levels and the severity of VL, and whether PCT levels can be used as a diagnostic marker for secondary bacterial infections in such patients. A meta-analysis of 10 diagnostic studies revealed that serum PCT has a sensitivity and specificity of 79 and 89% respectively for the diagnosis of bacterial infections in cirrhotic patients. Procalcitonin levels can be useful in early identification of bacterial pneumonia, guide antibiotic management, and help stratify patients with a higher risk of developing complications. In a meta-analysis involving 30 studies and 3244 critically ill patients, the authors concluded that PCT is a helpful biomarker for early diagnosis of sepsis in critically ill patients. Procalcitonin can be useful in the diagnosis of bacterial joint infections in patients with inflammatory rheumatic diseases . A meta-analysis on the diagnostic value of PCT in osteoarticular infections indicated that PCT may be more suitable as a marker for rule-in diagnosis rather than for exclusion of septic arthritis or osteomyelitis, and that use of a lower cutoff value at 0.2–0.3 ng/mL may improve its diagnostic performance . All other studies were categorized as having a low risk in this aspect. In the reference standard domain, two (28.5%) studies had an unclear risk of bias because CDI may be subjectively determined by healthcare providers and cannot be confirmed to be unaffected by the index test 19, 25. Within the patient selection domain, all studies were deemed to carry a low risk of bias due to their comprehensive descriptions of enrollment design. The PCT cutoff value for detecting infection ranged from 0.105 (mg/L) to 1.695 (mg/L), with a median value of 0.5 (mg/L).