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Ian, Please also note that all those systematic reviews have summarized the evidence available on diagnostic accuracy, whereas there are other sorts of evidence, of higher clinical significance than diagnostic accuracy. Below are the references of 2 RCTs which tend to suggest that procalcitonin might be useful to guide antibiotic therapy, allowing to decrease antibiotic use and therefore their numerous side effects as well as costs (antibiotics being much more expensive than PCT testing). Such results still need however to be confirmed in critical care. Chest. 2007 Jan;131(1):9-19. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Stolz D, Christ-Crain M, Bingisser R, Leuppi J, Miedinger D, Müller C, Huber P, Müller B, Tamm M. Am. J. Respir. Crit. Care Med. 2006 Jul 1;174(1):84-93. Epub 2006 Apr 7. Procalcitonin Guidance of Antibiotic Therapy in Community-acquired Pneumonia: A Randomized Trial. Christ-Crain M, Stolz D, Bingisser R, Müller C, Miedinger D, Huber PR, Zimmerli W, Harbarth S, Tamm M, Müller B. Dr Joseph Watine, PH, AIHP, PharmD, AAHU, EurClinChem Laboratoire de Biologie Polyvalente Centre Hospitalier Général 12027 Rodez Cedex 9 France >From: "Ian Barlow" <[log in to unmask]> >To: "Joseph WATINE" <[log in to unmask]> >Subject: RE: Procalcitonin >Date: Tue, 10 Jul 2007 14:23:52 +0100 > >I must admit to not picking up on that Joseph. >Many thanks once again. >Ian > >-----Original Message----- >From: Clinical biochemistry discussion list >[mailto:[log in to unmask]]On Behalf Of Joseph WATINE >Sent: 10 July 2007 14:07 >To: [log in to unmask] >Subject: Re: Procalcitonin > > >Many thanks Ian, > >Have you noticed that Tang et al's meta-analysis seems to be the only one >which used statistical analysis (Egger's regression model) to detect >publication bias? > >Tang et al's thus showed that the missing studies were located at the left >of the funnel plot; consistent with the general observation that studies >with less optimistic estimation of diagnostic performance are less likely >to >be published. > >Best regards, > >Joseph > > >From: Ian Barlow <[log in to unmask]> > >Reply-To: Ian Barlow <[log in to unmask]> > >To: [log in to unmask] > >Subject: Re: Procalcitonin > >Date: Mon, 9 Jul 2007 12:36:22 +0100 > > > >Dear colleagues, > > > >Is procalcitonin better than CRP? > > > >Thanks to Joseph and David for these references. > > > >I attach a short summary of these reviews and also include my > >interpretation of things as they are now. > > > >Best wishes > > > >Ian Barlow > >Scunthorpe > >UK > > > > > > > > > > > >-----Original Message----- > >From: Clinical biochemistry discussion list > >[mailto:[log in to unmask]]On Behalf Of Joseph WATINE > >Sent: 20 June 2007 09:19 > >To: [log in to unmask] > >Subject: Re: Procalcitonin > > > > > >in addition to these 2 articles, at least 5 other systematic reviews or > >meta-analysis have been published on the subject. Apparently some of the > >conclusions of these 7 articles seem to contradict with each other. >Please > >feel free to critically summarize these conclusions for us: > > > >1) Gattas DJ, Cook DJ. Procalcitonin as a diagnostic test for sepsis: > >health > >technology assessment in the ICU. J Crit Care. 2003 Mar;18(1):52-8. > >2) Sponholz C, Sakr Y, Reinhart K, Brunkhorst F. Diagnostic value and > >prognostic implications of serum procalcitonin after cardiac surgery: a > >systematic review of the literature. Crit Care. 2006 Oct 13;10(5):R145 > >3) van Rossum AM, Wulkan RW, Oudesluys-Murphy AM. Procalcitonin as an >early > >marker of infection in neonates and children. Lancet Infect Dis. 2004 > >Oct;4(10):620-30. > >4) Shafiq N, Malhotra S, Bhasin DK, Rana S, Siddhu S, Pandhi P. >Estimating > >the diagnostic accuracy of procalcitonin as a marker of the severity of > >acute pancreatitis: a meta-analytic approach. JOP. 2005 May >10;6(3):231-7. > >5) Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA. Procalcitonin >Test > >in the Diagnosis of Bacteremia: A Meta-analysis. Ann Emerg Med. 2006 Dec >8; > >[Epub ahead of print] > > > >Dr Joseph Watine, PH, AIHP, PharmD, AAHU, EurClinChem > >Laboratoire de Biologie Polyvalente > >Centre Hospitalier Général > >12027 Rodez Cedex 9 > >France > > > > > > >From: David Gaze <[log in to unmask]> > > >Reply-To: David Gaze <[log in to unmask]> > > >To: [log in to unmask] > > >Subject: Procalcitonin > > >Date: Wed, 20 Jun 2007 07:39:19 +0100 > > > > > > > > > > > >Ian, > > > > > > > > > > > >See: > > > > > >1. Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret G-Y. > > >Procalcitonin as a diagnostic test for sepsis in critically ill adults > > >and after surgery or trauma: a systematic review and meta-analysis. >Crit > > >Care Med 2006; 34: 1996-2003 > > > > > > > > > > > >Regards > > > > > > > > > > > > > > > > > > > > > > > >David C Gaze > > > > > >Cardiac Research Scientist > > > > > >Chemical Pathology > > > > > >Jenner Wing, Level 2 > > > > > >St George's Healthcare NHS Trust > > > > > >London, SW17 0QT > > > > > >Tel: +44 (0)20 8725 5878 > > > > > >Fax: +44 (0)20 8682 0744 > > > > > >Email: [log in to unmask] > > ><mailto:[log in to unmask] _________________________________________________________________ Personnalisez votre Messenger avec Live.com http://www.windowslive.fr/livecom/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. 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