The purpose of our studies was to systematically assess the accuracy and clinical value of plasma calcitonin in patients with liver failure complicated with bacterial infection. In this study, we included prospective observational studies or randomized controlled trials on PCT. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Heterogeneity, pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, the area under the summary receiver operating characteristic curve (SROC), and metaregression analysis were performed using Stata16.0 software. Consequently, the studies revealed substantial heterogeneity (I² = 96, 95% confidence interval (95% CI) = 94–99). The results of meta-analysis using random effect models suggested that the combined DOR was 10.67 (95% CI = 3.73–30.53). In addition, the threshold effect analysis showed that the threshold effect was 0.23 and the correlation coefficient was −0.48, indicating that there was no threshold effect. In the forest map, the DOR of each study and the combined DOR are not distributed along the same line, and Q = 2.2 × 10¹⁴, . Furthermore, the metaregression analysis of PCT study design, bacterial infection site, and mean age displayed that the values were >0.05. The combined sensitivity was 0.77 (95% CI = 0.54–0.90), the combined specificity was 0.76 (95% CI = 0.70–0.82), the combined positive likelihood ratio was 3.25 (95% CI = 2.33–4.52), the combined negative likelihood ratio was 0.30 (95% CI = 0.14–0.67), and the combined AUC was 0.80 (95% CI = 0.76–0.83). In conclusion, PCT has moderate diagnostic value for adult liver failure complicated with bacterial infection, and it is a better auxiliary diagnostic index for liver failure with bacterial infection. However, the results of procalcitonin must be carefully interpreted combined with medical history, physical examination, and microbiological assessment.

中文翻译：

---

降钙素原对肝衰竭细菌感染的诊断准确性：荟萃分析

我们研究的目的是系统评估血浆降钙素在肝功能衰竭合并细菌感染患者中的准确性和临床价值。在这项研究中，我们纳入了关于 PCT 的前瞻性观察研究或随机对照试验。使用诊断准确性研究质量评估-2 (QUADAS-2) 工具评估研究质量。使用 Stata16.0 软件进行异质性、汇总诊断比值比 (DOR)、汇总灵敏度、汇总特异性、汇总阳性似然比、汇总阴性似然比、汇总受试者工作特征曲线下面积 (SROC) 和元回归分析。因此，这些研究揭示了大量的异质性（I ² = 96, 95% 置信区间 (95% CI) = 94–99)。使用随机效应模型的荟萃分析结果表明，综合 DOR 为 10.67（95% CI = 3.73–30.53）。此外，阈值效应分析表明，阈值效应为0.23，相关系数为-0.48，说明不存在阈值效应。在森林图中，每个研究的 DOR 和组合 DOR 不沿同一条线分布，Q  = 2.2 × 10 ¹⁴，. 此外，PCT 研究设计、细菌感染部位和平均年龄的元回归分析显示这些值 >0.05。综合敏感性为 0.77（95% CI = 0.54-0.90），综合特异性为 0.76（95% CI = 0.70-0.82），综合阳性似然比为 3.25（95% CI = 2.33-4.52），综合阴性似然比为 0.30（95% CI = 0.14–0.67），合并 AUC 为 0.80（95% CI = 0.76–0.83）。综上所述，PCT对成人肝衰竭合并细菌感染具有中等诊断价值，是较好的细菌感染肝衰竭辅助诊断指标。然而，必须结合病史、体格检查和微生物学评估仔细解释降钙素原的结果。