Procalcitonin and presepsin for detecting bacterial infection and spontaneous bacterial peritonitis in cirrhosis: A systematic review and meta-analysis

Figure 1 Flow chart showing the number of articles (n) included during the identification and selection processes.

Figure 2 Methodological evaluation of the included studies according to the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. A: Percentage of studies grouped according to risk of bias; B: Percentage of studies grouped according to concerns regarding applicability.

Figure 3 Summary receiver operating characteristic curves summarizing the overall diagnostic accuracy of procalcitonin and presepsin for diagnosing bacterial infections and spontaneous bacterial peritonitis. A: Procalcitonin for diagnosing bacterial infections; B: Presepsin for diagnosing bacterial infections; C: Procalcitonin for diagnosing spontaneous bacterial peritonitis.

Figure 4 Forest plots of sensitivity and specificity of procalcitonin and presepsin for diagnosing bacterial infections and spontaneous bacterial peritonitis. A: Procalcitonin for diagnosing bacterial infections; B: Presepsin for diagnosing bacterial infections; C: Procalcitonin for diagnosing spontaneous bacterial peritonitis in patients with cirrhosis. FN: False negative; FP: False positive; TN: True negative; TP: True positive.

Figure 5 Diagnostic performance of procalcitonin and presepsin for diagnosing bacterial infections and spontaneous bacterial peritonitis. A: Procalcitonin for diagnosing bacterial infections; B: Presepsin for diagnosing bacterial infections; C: Procalcitonin for diagnosing spontaneous bacterial peritonitis among patients with cirrhosis: Fagan nomogram. NLR: Negative likelihood ratio; PLR: Positive likelihood ratio; prob: Probability; SBP: Spontaneous bacterial peritonitis.

Figure 6 Funnel plot for studies. A: Sensitivity of procalcitonin for diagnosing bacterial infection; B: Specificity of procalcitonin for diagnosing bacterial infection; C: Sensitivity of procalcitonin for diagnosing spontaneous bacterial peritonitis; D: Specificity of procalcitonin for diagnosing spontaneous bacterial peritonitis.

Figure 7 Mechanism of serum procalcitonin and presepsin in response to bacterial infection. IL-1: Interleukin-1; IL-6: Interleukin-6; LBP: Lipopolysaccharide binding protein; LPS: Lipopolysaccharide; mCD14: Membrane-CD14; sCD14: Soluble CD14; sCD14-ST: Soluble CD14-subtype; TNF-α: Tumor necrotic factor-alpha.