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en el propio SUH&#44; se toman muestras para los distintos estudios microbiol&#243;gicos hasta en un 45&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Entre ellos predomina la obtenci&#243;n de hemocultivos &#40;HC&#41;&#44; que se lleva a cabo en el 15&#37; de todos los pacientes atendidos con sospecha o confirmaci&#243;n de infecci&#243;n en los SUH<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;9-11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La sepsis y la infecci&#243;n bacteriana grave son claros ejemplos de enfermedad &#171;tiempo-dependiente&#187;&#46; El SUH representa uno de los eslabones clave donde se establece la sospecha y el diagn&#243;stico y se inicia el tratamiento guiado por objetivos &#40;&#171;paquetes de medidas&#187;&#41;&#44; lo que determinar&#225; la evoluci&#243;n y el pron&#243;stico en funci&#243;n de la rapidez de estas actuaciones<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1-3</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Pero las manifestaciones cl&#237;nicas de los procesos infecciosos son a menudo inespec&#237;ficas y variables &#40;especialmente en el anciano o en el inmunodeprimido&#41;&#44; lo que dificulta el reconocimiento precoz de estos enfermos y estas situaciones&#46; Todo ello favorece que se prescriban AB innecesarios sin la certeza de que el cuadro sea infeccioso y de origen bacteriano&#44; sobre todo en pacientes con s&#237;ndrome febril de origen desconocido en el SUH &#40;del 30 al 50&#37; de las ocasiones de etiolog&#237;a no infecciosa se prescriben AB&#41;&#44; con la consiguiente presi&#243;n antibi&#243;tica y la posibilidad de aumento de las resistencias y de la virulencia bacterianas<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">6&#44;12&#44;13</span></a>&#46; Esta realidad representa un verdadero problema&#44; al conllevar un incremento de las pruebas diagn&#243;sticas realizadas&#44; de la estancia hospitalaria&#44; de los costes y la administraci&#243;n en ocasiones de tratamientos antibi&#243;ticos innecesarios o&#44; en otros casos&#44; la no administraci&#243;n precoz<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1-3&#44;6&#44;13</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En este contexto cl&#237;nico&#44; en los &#250;ltimos a&#241;os&#44; se ha acentuado la b&#250;squeda de herramientas objetivas de ayuda para intentar predecir&#44; desde la primera valoraci&#243;n del paciente con sospecha de infecci&#243;n grave&#44; un diagn&#243;stico precoz&#44; el pron&#243;stico&#44; la gravedad y&#44; junto con la posible etiolog&#237;a bacteriana&#44; la sospecha de bacteriemia &#40;al ser estos factores claramente determinantes del pron&#243;stico y la mortalidad de los procesos infecciosos&#41;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1-3&#44;13</span></a>&#46; En esta l&#237;nea&#44; los biomarcadores de respuesta inflamatoria e infecci&#243;n &#40;BMRIeI&#41; se han posicionado como herramientas de gran ayuda para el cl&#237;nico a la hora de mejorar el diagn&#243;stico y el tratamiento de la infecci&#243;n&#44; al facilitar y adelantar la toma de decisiones vitales en el SUH<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; Ya desde la conferencia de expertos en sepsis del a&#241;o 2001 &#40;Sepsis-2&#41;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">16</span></a>&#44; se reconoci&#243; la importancia de los BMRIeI&#44; particularmente la prote&#237;na C reactiva &#40;PCR&#41; y la procalcitonina &#40;PCT&#41;&#44; en el reconocimiento temprano del paciente con infecci&#243;n grave&#44; en la evaluaci&#243;n de la respuesta inflamatoria y en la estratificaci&#243;n del riesgo de los pacientes&#46; En la actualidad&#44; entre todos ellos&#44; la PCT sigue destacando como un biomarcador sensible y espec&#237;fico para predecir infecci&#243;n bacteriana&#44; guiar hacia el pat&#243;geno causante de la infecci&#243;n&#44; prever su evoluci&#243;n cl&#237;nica &#40;hacia sepsis grave y shock s&#233;ptico&#41; y la mortalidad asociada<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;2&#44;15&#44;17-20</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Sin embargo&#44; en noviembre de 2021&#44; la publicaci&#243;n de las gu&#237;as de la Surviving Sepsis Campaign 2021 gener&#243; cierta controversia<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">3</span></a>&#46; Estas gu&#237;as recomendaron que&#44; para pacientes adultos con sospecha de sepsis o shock s&#233;ptico no se utilice la PCT junto con la evaluaci&#243;n cl&#237;nica para decidir cu&#225;ndo comenzar con antimicrobianos &#40;y&#44; por extensi&#243;n&#44; tampoco para la sospecha de infecci&#243;n bacteriana grave&#41;&#44; en comparaci&#243;n con la evaluaci&#243;n cl&#237;nica sola&#46; Esta recomendaci&#243;n se considera como una &#171;recomendaci&#243;n d&#233;bil con evidencia de muy baja calidad&#187; y carece de estudios espec&#237;ficos en los SUH que la respalden<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">3</span></a>&#46; Dos a&#241;os despu&#233;s&#44; en una actualizaci&#243;n de la Surviving Sepsis Campaign en el a&#241;o 2023&#44; estas gu&#237;as internacionales no han modificado dicha recomendaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">21</span></a>&#46; Posteriormente&#44; algunas sociedades cient&#237;ficas de urgencias&#44; tanto latinoamericanas como espa&#241;olas&#44; en la valoraci&#243;n cl&#237;nica inicial del paciente con sospecha de infecci&#243;n&#44; han recomendado la determinaci&#243;n de PCT para apoyar la sospecha cl&#237;nica de infecci&#243;n bacteriana&#44; la posibilidad de bacteriemia y&#44; por ende&#44; para guiar el inicio de la antibioterapia<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;2&#44;8</span></a>&#46; M&#225;s recientemente&#44; una revisi&#243;n sistem&#225;tica ha mostrado la utilidad de la PCT para sospechar la presencia de bacteriemia en pacientes con diagn&#243;stico cl&#237;nico de infecci&#243;n en SUH&#44; recomendando la extracci&#243;n de hemocultivos y la administraci&#243;n de antibi&#243;ticos en estos casos<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Por todo ello&#44; el objetivo principal de esta revisi&#243;n sistem&#225;tica es investigar la precisi&#243;n diagn&#243;stica de la PCT para predecir infecci&#243;n bacteriana en los pacientes adultos atendidos con sospecha cl&#237;nica de infecci&#243;n en el SUH&#44; as&#237; como analizar si los distintos estudios logran identificar un valor espec&#237;fico de PCT como el m&#225;s relevante desde el punto de vista diagn&#243;stico de decisi&#243;n cl&#237;nica que pueda recomendarse para la toma de decisiones en los SUH&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se realiz&#243; una revisi&#243;n sistem&#225;tica &#40;RS&#41; con base en lo establecido por la lista declaraci&#243;n Preferred Reporting Items for Sytematic Reviews and Meta-Analyses &#40;PRISMA&#41;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">23</span></a>&#46; El protocolo de la revisi&#243;n ha sido registrado en PROSPERO &#40;CRD42023489722&#41; y es accesible a trav&#233;s del link <a href="https://www.crd.york.ac.uk/PROSPEROFILES/489722_STRATEGY_20231204.pdf">https&#58;&#47;&#47;www&#46;crd&#46;york&#46;ac&#46;uk&#47;PROSPEROFILES&#47;489722&#95;STRATEGY&#95;20231204&#46;pdf</a>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Pregunta PICO</span><p id="par0050" class="elsevierStylePara elsevierViewall">La pregunta de investigaci&#243;n se formul&#243; siguiendo las recomendaciones del formato PICO &#40;Poblaci&#243;n&#47;paciente&#44; Intervenci&#243;n&#44; Comparador y Outcomes&#47;desenlaces&#41;&#46; Nuestra pregunta fue&#58; &#171;En pacientes adultos atendidos en el SUH con el diagn&#243;stico cl&#237;nico de sospecha de infecci&#243;n bacteriana &#40;P&#41;&#44; &#191;el uso de la procalcitonina &#40;C&#41; en comparaci&#243;n con su no utilizaci&#243;n &#40;I&#41; mejora la precisi&#243;n de la predicci&#243;n diagn&#243;stica de infecci&#243;n bacteriana en los SUH &#40;O&#41;&#63;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Estrategia de b&#250;squeda y criterios de selecci&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se realiz&#243; una b&#250;squeda bibliogr&#225;fica en las bases de datos de PubMed&#44; Web of Sciencie&#44; EMBASE&#44; Lilacs&#44; Cochrane&#44; Epistemonikos&#44; Tripdatabase y ClinicalTrials&#46;gov dirigida a localizar art&#237;culos que evaluasen el rendimiento diagn&#243;stico de la PCT para la predicci&#243;n de infecci&#243;n bacteriana en pacientes adultos atendidos en los SUH&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La estrategia de b&#250;squeda inicial combin&#243; los t&#233;rminos MeSH <span class="elsevierStyleItalic">&#40;Procalcitonin&#41;</span> AND <span class="elsevierStyleItalic">&#40;Infection OR Bacterial Infection OR Sepsis&#41;</span> de forma inicial en todas las bases de datos sin restricciones de idioma desde enero del 2005 hasta el 31 de mayo del 2023&#46; En un segundo paso&#44; se incluyeron los t&#233;rminos <span class="elsevierStyleItalic">&#40;Emergencies OR Emergency OR Emergency Department&#41;</span> y&#44; tercero los t&#233;rminos <span class="elsevierStyleItalic">&#40;Adults&#41;</span> AND <span class="elsevierStyleItalic">&#40;Diagnostic&#41;&#46;</span> Siendo las estrategias de b&#250;squedas secundarias&#58; &#40;Emergency OR Emergencies OR Emergency department&#41; AND <span class="elsevierStyleItalic">&#40;procalcitonin&#41;</span> AND <span class="elsevierStyleItalic">&#40;Infection OR Bacterial Infection OR Sepsis&#41;</span> y <span class="elsevierStyleItalic">&#40;Emergency OR Emergencies OR Emergency Department&#41;</span> AND <span class="elsevierStyleItalic">&#40;Procalcitonin&#41;</span> AND <span class="elsevierStyleItalic">&#40;Infection OR Bacterial Infection OR Sepsis&#41;</span> AND <span class="elsevierStyleItalic">&#40;diagnostic&#41;</span> AND <span class="elsevierStyleItalic">&#40;adults&#41;&#46;</span></p><p id="par0065" class="elsevierStylePara elsevierViewall">Finalmente&#44; en todas las secuencias de b&#250;squeda se prioriz&#243; la inclusi&#243;n de RS&#44; RS-metaan&#225;lisis y estudios de cohortes observacionales &#40;anal&#237;ticos de rendimiento diagn&#243;stico&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Criterios de inclusi&#243;n y exclusi&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">Criterios de inclusi&#243;n&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Pacientes adultos &#40;mayores de 14 a&#241;os&#41; atendidos en el SUH con la sospecha cl&#237;nica y confirmaci&#243;n de un proceso infeccioso bacteriano &#40;con o sin criterios de sepsis&#41; originado en la comunidad&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Para ser incluido entre los estudios de an&#225;lisis&#44; el art&#237;culo informaba sobre las estimaciones de precisi&#243;n diagn&#243;stica para infecci&#243;n bacteriana de la PCT &#40;dando a conocer el &#225;rea bajo la curva &#91;ABC&#93; o al menos la sensibilidad &#91;Se&#93;&#44; la especificidad &#91;Es&#93; y los valores p correspondientes&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">La valoraci&#243;n cl&#237;nica&#44; as&#237; como la extracci&#243;n de la anal&#237;tica y de la PCT &#40;sangu&#237;nea&#41; y de los HC y otros estudios microbiol&#243;gicos se debe haber hecho en la primera atenci&#243;n del paciente en el &#225;mbito del SUH&#44; siempre dentro de las primeras 24 h desde la llegada del paciente al hospital&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Los estudios proporcionaban una descripci&#243;n de los grupos de pacientes con y sin infecci&#243;n bacteriana&#44; as&#237; como de las variables demogr&#225;ficas&#44; epidemiol&#243;gicas&#44; cl&#237;nicas&#44; etc&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">En el caso de la PCT &#40;t&#233;cnicas y m&#233;todos de detecci&#243;n utilizados son cuantitativos&#41;&#44; dada la falta de estandarizaci&#243;n para su medida&#44; solo se incluyeron aquellos estudios en los que dicha magnitud fuera medida mediante ensayos BRAHMS-<span class="elsevierStyleItalic">like</span><a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">24</span></a>&#46;</p></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">Criterios de exclusi&#243;n&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Pacientes en edad pedi&#225;trica &#40;&#8804; 14 a&#241;os&#41; o pacientes mixtos &#40;pedi&#225;tricos y adultos&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0110" class="elsevierStylePara elsevierViewall">Pacientes atendidos o valorados en otros servicios y entornos &#40;Medicina Intensiva-Cr&#237;ticos&#44; posquir&#250;rgicos&#44; hospitalizaci&#243;n&#44; Atenci&#243;n Primaria&#41; o en un entorno distinto del SUH o en entornos mixtos &#40;SUH m&#225;s otros servicios&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall">Posible origen nosocomial del proceso infeccioso&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0120" class="elsevierStylePara elsevierViewall">Art&#237;culos con baja potencia o muestra considerada limitada &#40;escaso n&#250;mero de episodios de infecci&#243;n bacteriana&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">Art&#237;culos que valoran exclusivamente la precisi&#243;n diagn&#243;stica de la PCT para predecir bacteriemia verdadera en los pacientes adultos atendidos con sospecha cl&#237;nica de infecci&#243;n en el SUH&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">Estudios de casos y controles&#44; revisiones narrativas&#44; informes de casos&#44; editoriales&#44; comentarios o puntos de vista&#44; cartas al director&#44; res&#250;menes de reuniones o congresos&#44; presentaciones de carteles&#47;p&#243;steres&#44; etc&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Extracci&#243;n de datos y an&#225;lisis de la calidad</span><p id="par0135" class="elsevierStylePara elsevierViewall">La selecci&#243;n de los art&#237;culos se determin&#243; utilizando las fases del m&#233;todo PRISMA<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">23</span></a>&#58; <span class="elsevierStyleItalic">1&#41;</span> identificaci&#243;n&#44; <span class="elsevierStyleItalic">2&#41;</span> cribado&#59; <span class="elsevierStyleItalic">3&#41;</span> elegibilidad &#40;idoneidad&#41;&#44; y <span class="elsevierStyleItalic">4&#41;</span> inclusi&#243;n definitiva de art&#237;culos en la revisi&#243;n&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">De cada estudio incluido se extrajo la siguiente informaci&#243;n&#58; primer autor&#59; a&#241;o publicaci&#243;n&#59; pa&#237;s&#59; tama&#241;o de la muestra&#59; dise&#241;o del estudio&#59; porcentaje de infecci&#243;n bacteriana&#59; edad media &#40;o mediana&#41; y sexo&#59; tipo paciente&#47;proceso&#47;foco&#59; rendimiento diagn&#243;stico de la PCT seg&#250;n disponibilidad de los datos que se encontraron&#58; Se&#44; Es&#44; valor predictivo positivo &#40;VPP&#41;&#44; valor predictivo negativo &#40;VPN&#41; y el ABC de la caracter&#237;stica operativa del receptor &#40;ABC-COR&#41; con sus intervalos de confianza del 95&#37; &#40;IC del 95&#37;&#41; cuando estos determinandos y el IC del 95&#37; estaban reflejados en los art&#237;culos originales&#44; y el punto o valor de decisi&#243;n &#40;corte&#41; elegido en cada estudio seg&#250;n el &#237;ndice de Youden o la m&#225;xima sensibilidad obtenida o predeterminado por los autores &#40;seg&#250;n lo registrado en cada estudio&#41;&#46; Adem&#225;s&#44; se incluye un comentario sobre el tipo de t&#233;cnica y el m&#233;todo utilizado para el an&#225;lisis de la PCT&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Todos estos datos se compararon por tablas &#40;al no realizarse t&#233;cnicas de s&#237;ntesis en este art&#237;culo&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Se consider&#243; ABC-COR adecuado cuando se obtuviera un valor entre 0&#44;8 y 0&#44;9&#44; muy bueno<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;9 y perfecto si el resultado fue 1<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En el caso de ausencia de ciertos datos relevantes analizados en alguno de los estudios&#44; se intent&#243; contactar con los autores principales para facilitar los datos no publicados o no accesibles&#46; En estos casos&#44; si se recibieron la respuesta y el dato&#44; se incluyeron&#46; Pero si no se consiguieron&#44; por no existir o no haber respuesta&#44; se excluy&#243; dicho estudio del an&#225;lisis concreto para el que no se hubiera recuperado la informaci&#243;n&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En la fase de elegibilidad 3<span class="elsevierStyleHsp" style=""></span>revisores &#40;LGGR&#44; GMS y AJJ&#41; realizaron la lectura completa del texto de los art&#237;culos y los evaluaron de forma independiente y&#44; posteriormente&#44; extrajeron los datos&#46; En caso de desacuerdo&#44; se discuti&#243; con un cuarto revisor &#40;DEG&#41; y se lleg&#243; a un consenso un&#225;nime&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Para valorar la calidad del m&#233;todo empleado y el riesgo de sesgos de los art&#237;culos de cohortes de precisi&#243;n diagn&#243;stica incluidos en esta RS se utiliz&#243; la Newcastle-Ottawa Scale &#40;NOS&#41;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">26</span></a> para estudios de cohortes &#40;valorada individualmente por 2<span class="elsevierStyleHsp" style=""></span>revisores&#41;&#46; Los criterios para la evaluaci&#243;n cualitativa comprendieron 3<span class="elsevierStyleHsp" style=""></span>&#237;tems principales&#58; selecci&#243;n de muestra&#44; comparabilidad y exposici&#243;n&#46; Cada uno de estos &#237;tems ten&#237;a preguntas con opciones y podr&#237;a recibir 1 o 2 puntos &#40;estrellas&#47;&#42;&#41; si se cumpl&#237;an los criterios&#46; Los estudios con puntuaciones totales de 1-3&#44; 4-6 y 7-9 se definieron como de baja calidad metodol&#243;gica &#40;alto riesgo de sesgos&#41;&#44; media y alta calidad &#40;bajo riesgo de sesgos&#41;&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">No se realiz&#243; transformaci&#243;n de los datos ni se abord&#243; el sesgo de publicaci&#243;n&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Finalmente&#44; no se realizaron t&#233;cnicas de metaan&#225;lisis&#44; pero los resultados se compararon narrativamente y se estimaron las medias de los desenlaces cr&#237;ticos&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Selecci&#243;n de estudios</span><p id="par0180" class="elsevierStylePara elsevierViewall">El diagrama de flujo de la b&#250;squeda bibliogr&#225;fica y selecci&#243;n definitiva de los art&#237;culos a incluir se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#44; de acuerdo con las fases del m&#233;todo PRISMA<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">23</span></a>&#58; <span class="elsevierStyleItalic">1&#41;</span> identificaci&#243;n&#59; <span class="elsevierStyleItalic">2&#41;</span> cribado&#59; <span class="elsevierStyleItalic">3&#41;</span> elegibilidad &#40;idoneidad&#41;&#44; y&#44; <span class="elsevierStyleItalic">4&#41;</span> inclusi&#243;n definitiva de art&#237;culos en la revisi&#243;n&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">Se identificaron inicialmente 1&#46;323 art&#237;culos en las bases de datos seleccionadas&#46; Los estudios excluidos tras la lectura a texto completo fueron 117&#46; Finalmente&#44; 21 estudios de cohortes fueron los art&#237;culos que se incluyeron en esta RS&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Caracter&#237;sticas de los estudios incluidos</span><p id="par0190" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las caracter&#237;sticas de los 21 art&#237;culos de cohortes incluidos en esta revisi&#243;n&#44; finalmente en 2<span class="elsevierStyleHsp" style=""></span>idiomas &#40;ingl&#233;s y espa&#241;ol&#41;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">17&#44;27-46</span></a>&#44; que fueron publicados desde el 2005<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">27</span></a> hasta el 2022<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">17&#44;46</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0195" class="elsevierStylePara elsevierViewall">Nueve de los estudios se desarrollaron en pa&#237;ses europeos<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">28-32&#44;35&#44;39&#44;45&#44;46</span></a>&#44; 6<span class="elsevierStyleHsp" style=""></span>en Espa&#241;a<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">17&#44;33&#44;40-43</span></a>&#44; 4<span class="elsevierStyleHsp" style=""></span>en Asia<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">27&#44;34&#44;36&#44;38</span></a> y 2<span class="elsevierStyleHsp" style=""></span>en Am&#233;rica &#40;Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">44</span></a> y Colombia<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">37</span></a>&#41;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">En total se ha incluido a 10&#46;333 pacientes con 4&#46;856 casos de infecciones bacterianas &#40;47&#37;&#41;&#46; Las poblaciones fueron heterog&#233;neas ya que presentaron un porcentaje de infecciones bacterianas confirmadas desde el 12&#37;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">28</span></a> hasta el 68&#37;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">29</span></a>&#44; 20<span class="elsevierStyleHsp" style=""></span>fueron prospectivos&#44; 4<span class="elsevierStyleHsp" style=""></span>multic&#233;ntricos&#59; todos los pacientes eran adultos con una edad media desde 35 &#40;DE 15&#41; a&#241;os<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">28</span></a> hasta mediana de 71 &#40;58-78&#41; a&#241;os<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">34</span></a> y la proporci&#243;n de hombres vari&#243; desde el 44&#37;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">38</span></a> hasta el 67&#37;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">40</span></a>&#46; La mayor&#237;a de los estudios &#40;13&#41; se elaboraron en pacientes con fiebre o sospecha de infecci&#243;n bacteriana con o sin criterios de sepsis<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">17&#44;27&#44;30&#44;31&#44;33-37&#44;41&#44;43&#44;45&#44;46</span></a>&#44; 5<span class="elsevierStyleHsp" style=""></span>en diagnosticados de meningitis<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">28&#44;32&#44;38&#44;40&#44;42</span></a>&#44; 2<span class="elsevierStyleHsp" style=""></span>en pacientes con neumon&#237;a adquirida en la comunidad &#40;NAC&#41;<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">29&#44;39</span></a> y uno con infecci&#243;n del tracto urinario &#40;ITU&#41;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">44</span></a>&#46; Todos los estudios incluyeron criterios o definiciones para considerar infecci&#243;n bacteriana&#44; as&#237; como otros tipos de infecciones y etiolog&#237;a no infecciosa&#46; Todos los estudios incluidos utilizaron t&#233;cnicas y m&#233;todos cuantitativos mediante ensayos BRAHMS-<span class="elsevierStyleItalic">like</span> para la obtenci&#243;n de valores de PCT<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">24</span></a>&#46; Por su parte&#44; los puntos de corte o de decisi&#243;n de PCT considerados con mejor rendimiento o valor cl&#237;nico por los autores oscilaron entre 0&#44;1 ng&#47;ml<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">29-31&#44;44&#44;46</span></a> hasta 2&#44;13 ng&#47;ml<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">28</span></a>&#46; Aunque el valor de 0&#44;20-0&#44;30 ng&#47;ml de PCT es el m&#225;s utilizado y propuesto en 12<span class="elsevierStyleHsp" style=""></span>estudios<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">29-32&#44;34&#44;36&#44;37&#44;39&#44;41&#44;44-46</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestra la evaluaci&#243;n de la calidad de los estudios de cohortes incluidos y de sus riesgos de sesgos seg&#250;n la escala NOS<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">26</span></a>&#58; 8 de ellos fueron calificados de calidad alta &#40;bajo riesgo de sesgos&#41;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">17&#44;30&#44;31&#44;34&#44;36&#44;40&#44;42&#44;46</span></a>&#44; 9 moderada<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">28&#44;32&#44;33&#44;37&#44;38&#44;41&#44;43-45</span></a> y 4 baja &#40;alto riesgo de sesgos&#41;<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">27&#44;29&#44;35&#44;39</span></a>&#46; La media de los 21 estudios v&#225;lidos incluidos fue de 6 puntos &#40;consider&#225;ndose de moderada calidad y mediano riesgo de sesgos&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Comparaci&#243;n y rendimientos diagn&#243;sticos de la procalcitonina seg&#250;n los distintos estudios y puntos de decisi&#243;n</span><p id="par0210" class="elsevierStylePara elsevierViewall">Los rendimientos conseguidos y la capacidad predictiva de la PCT para infecci&#243;n bacteriana son muy variables dependiendo del estudio &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; y&#44; entre otros determinantes&#44; del punto de corte o decisi&#243;n elegido&#46; El ABC-COR de todos los estudios se sit&#250;a desde 0&#44;68 &#40;IC del 95&#37;&#58; 0&#44;61-0&#44;72&#41;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">33</span></a> hasta 0&#44;99 &#40;IC del 95&#37;&#58; 0&#44;99-1<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">32</span></a> e IC del 95&#37;&#58; 0&#44;98-1&#41;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">40</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">El valor de punto de corte de 0&#44;20-0&#44;30 ng&#47;ml de PCT es el m&#225;s utilizado y propuesto hasta en 12<span class="elsevierStyleHsp" style=""></span>de los trabajos que se incluyen en esta revisi&#243;n sistem&#225;tica<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">29-32&#44;34&#44;36&#44;37&#44;39&#44;41&#44;44-46</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41; cuyo rendimiento medio estimado es de un ABC-COR de 0&#44;795&#46; Pero si solo tenemos en cuenta los resultados de los 5<span class="elsevierStyleHsp" style=""></span>estudios calificados de alta calidad &#40;bajo riesgo de sesgos&#41;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">30&#44;31&#44;34&#44;36&#44;46</span></a> que utilizan ese punto de corte de 0&#44;20-0&#44;30 ng&#47;ml de PCT&#44; el resultado medio estimado del ABC-COR obtenido es de 0&#44;778&#44; con Se&#58; 69&#37; y Es&#58; 76&#37;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall">En los estudios que predicen meningitis bacteriana<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">28&#44;32&#44;39&#44;40&#44;42</span></a> el ABC-COR es excelente en todos ellos variando entre 0&#44;96 a 0&#44;99&#44; con una Se&#58; 87-98&#37; y Es&#58; 89-100&#37;&#44; dependiendo del punto de corte que se elija &#40;entre 0&#44;28 y 2&#44;13 ng&#47;ml&#41;&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Por su parte&#44; los 2<span class="elsevierStyleHsp" style=""></span>estudios en pacientes con neumon&#237;a<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">29&#44;39</span></a> adoptando 0&#44;25 ng&#47;ml de PCT de punto de corte consiguen una ABC-COR de 0&#44;74 y 0&#44;88&#44; Se de 45 y 74&#37; y Es de 85&#37; en ambos&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Y en el estudio de pacientes con ITU<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">44</span></a> el ABC-COR es de 0&#44;72&#44; Se 67&#37; y Es 63&#37;&#44; con 0&#44;25 ng&#47;ml de punto de decisi&#243;n&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0235" class="elsevierStylePara elsevierViewall">Esta RS ha evaluado la capacidad predictiva de la PCT como biomarcador para la etiolog&#237;a bacteriana en pacientes adultos atendidos en el SUH con diagn&#243;stico cl&#237;nico de infecci&#243;n&#46; La evaluaci&#243;n se realiz&#243; de manera global&#44; considerando a todos los pacientes independientemente del foco infeccioso que los hubiera originado&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; se llev&#243; a cabo una evaluaci&#243;n secundaria del rendimiento predictivo espec&#237;fico para infecci&#243;n bacteriana&#44; estableciendo el punto de corte de la PCT entre 0&#44;2-0&#44;3 ng&#47;ml&#46; Este intervalo&#44; particularmente el valor de 0&#44;25 ng&#47;ml&#44; fue el m&#225;s frecuentemente designado por la mayor&#237;a de los art&#237;culos incluidos en la RS<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">29-32&#44;34&#44;36&#44;37&#44;39&#44;41&#44;44-46</span></a> y coincide con las recomendaciones de numerosos autores que han utilizado la PCT de manera aislada para predecir la existencia de infecci&#243;n bacteriana en pacientes con infecci&#243;n o sepsis en SUH<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;15</span></a>&#44; tanto en adultos como en mayores de 65 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">15&#44;20</span></a> y en aquellos diagnosticados con NAC<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">15&#44;20&#44;47-49</span></a>&#44; ITU<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">15&#44;44</span></a> o meningitis agudas<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">15&#44;50</span></a>&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Del mismo modo&#44; estos resultados refuerzan o corroboran los encontrados y publicados en otras &#225;reas asistenciales&#44; fundamentalmente pacientes pedi&#225;tricos<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">51</span></a>&#44; de planta de hospitalizaci&#243;n y&#44; sobre todo&#44; en los ingresados en las unidades de Cuidados Intensivos<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">52</span></a> o valorados en Atenci&#243;n Primaria<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">53</span></a>&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Los rendimientos y capacidad predictiva de la PCT para infecci&#243;n bacteriana en los pacientes en los SUH son heterog&#233;neos y var&#237;an desde ABC-COR desde 0&#44;68<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">33</span></a> hasta 0&#44;99<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">32&#44;40</span></a>&#46; Cuando el punto de corte elegido es 0&#44;2-0&#44;3&#40;0&#44;25&#41; ng&#47;ml de PCT&#44; que se corresponde con el m&#225;s aceptado en la actualidad por m&#250;ltiples autores<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">29-32&#44;34&#44;36&#44;37&#44;39&#44;41&#44;44-50</span></a>&#44; el resultado medio de esta RS consigue un ABC-COR de 0&#44;795 &#40;en el l&#237;mite del valor calificado como adecuado y &#250;til&#41;&#44; con una con Se del 70&#37; y Es del 76&#37;&#46; Cuando el PC elegido es superior &#40;p&#46; ej&#46;&#44; 0&#44;5 ng&#47;ml&#41; tanto el ABC-COR&#44; como la especificidad y el VPP se incrementan significativamente y&#44; adem&#225;s&#44; como una reciente RS ha publicado&#44; tambi&#233;n consigue una capacidad predictiva de bacteriemia muy buena &#40;ABC-COR 0&#44;89 con Se del 77&#44;6&#37; y Es del 78&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">22</span></a>&#44; en la l&#237;nea de lo publicado en otras revisiones<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">18&#44;19</span></a>&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Aunque se han publicado otras RS y metaan&#225;lisis previos sobre la precisi&#243;n diagn&#243;stica de la PCT para predecir infecci&#243;n bacteriana frente a infecciones virales u otras enfermedades agudas<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">15&#44;51-53</span></a>&#44; ninguna RS-metaan&#225;lisis ha evaluado su rendimiento en pacientes del SUH con procesos comunitarios desde el a&#241;o 2005&#46; De ah&#237;&#44; que esta revisi&#243;n trata de enfatizar la importancia de estos resultados para normalizar el uso de la PCT como herramienta de ayuda para predecir infecci&#243;n bacteriana frente a otras causas de fiebre o infecci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;15</span></a>&#44; bacteriemia<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">22</span></a> y de ayuda pron&#243;stica en los SUH<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">54</span></a>&#44; tal y como se usa en servicios de medicina cr&#237;tica o en pacientes hospitalizados<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3&#44;15&#44;51-53</span></a>&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Hist&#243;ricamente se ha utilizado tanto la PCR como la PCT para orientar el diagn&#243;stico de infecci&#243;n bacteriana y as&#237; optimizar la indicaci&#243;n de los antimicrobianos<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;15</span></a>&#46; As&#237;&#44; en el a&#241;o 2005 Simon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">52</span></a> publicaron un metaan&#225;lisis que inclu&#237;a 22 estudios y a 1&#46;386 pacientes hospitalizados donde se demostraba la mayor capacidad de la PCT frente a la PCR para distinguir infecci&#243;n bacteriana tanto de otras causas de respuesta inflamatoria sist&#233;mica &#40;ABC de 0&#44;82 vs<span class="elsevierStyleItalic">&#46;</span> 0&#44;73&#44; Se de 88&#37; vs<span class="elsevierStyleItalic">&#46;</span> 75&#37; y Es de 81&#37; vs<span class="elsevierStyleItalic">&#46;</span> 67&#37;&#41; como de infecci&#243;n v&#237;rica &#40;ABC de 0&#44;89 vs&#46; 0&#44;83&#44; Se de 92&#37; vs&#46; 86&#37; y Es de 73&#37; vs<span class="elsevierStyleItalic">&#46;</span> 70&#37;&#41;&#46; Otras revisiones m&#225;s recientes confirmaron estas conclusiones respecto a la superioridad de la capacidad diagn&#243;stica de la PCT para sospechar infecci&#243;n bacteriana y sepsis<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">53-55</span></a>&#46; Aunque otra RS &#40;Tang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">56</span></a>&#41; minimiza el valor de PCT y no la recomendar&#237;a de rutina&#44; esta se basa en pacientes de 18 estudios de los cuales solo 3 &#40;440 pacientes&#41; proceden del SUH&#44; por lo que estas limitaciones no permiten sacar conclusiones definitivas para los pacientes atendidos en los SUH&#46; En esta l&#237;nea&#44; en los estudios incluidos en nuestra RS a partir del a&#241;o 2005 con 10&#46;333 pacientes de los SUH &#40;4&#46;856 casos de infecciones bacterianas confirmadas&#41;&#44; mostramos un ABC-COR media estimada &#40;0&#44;80&#41; muy similar a la referida en estudios de otros servicios &#40;0&#44;82&#41;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">52</span></a>&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Por todo ello&#44; se puede aceptar como una herramienta de ayuda v&#225;lida para sospechar o predecir la existencia de infecci&#243;n bacteriana en el paciente con distintos procesos infecciosos &#40;fiebre&#44; sepsis&#44; neumon&#237;a&#44; ITU&#44; meningitis&#41; en los SUH&#46; Y&#44; de forma muy significada&#44; en los casos de meningitis bacteriana donde el ABC-COR es excelente en todos los estudios<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">28&#44;32&#44;38&#44;40&#44;42</span></a>&#44; variando entre 0&#44;96 a 0&#44;99&#44; con una Se&#58; 87-98&#37; y Es&#58; 89-100&#37;&#44; dependiendo del PC que se elija &#40;entre 0&#44;28 y 2&#44;13 ng&#47;ml&#41;&#46; Y gracias a los buenos VPN obtenidos para ayudar a descartar&#44; razonablemente&#44; la existencia de etiolog&#237;a bacteriana en estos pacientes&#44; con lo que esto implica para las decisiones urgentes a tomar en estas &#225;reas asistenciales como la indicaci&#243;n de extraer HC&#44; decidir el alta o ingreso&#44; tipo de terapia antimicrobiana&#44; entre otras<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;3&#44;12&#44;15</span></a>&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Hoy en d&#237;a cada vez es mayor la literatura relativa a distintos BMRIeI donde se eval&#250;a su capacidad predictiva o precisi&#243;n diagn&#243;stica de infecci&#243;n bacteriana&#44; como en el caso de la propia PCR&#44; interleucinas 6 y 8&#44; presepsina&#44; pro-ADM&#44; entre otros<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;15&#44;17&#44;18</span></a>&#46; Pero ninguno de ellos hasta el momento ha conseguido superar los resultados de la PCT &#40;de forma aislada o formando parte de un modelo o escala predictiva&#41;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1&#44;15&#44;17&#44;52&#44;57-60</span></a>&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Por ello&#44; junto con la disponibilidad actual generalizada de la PCT en los SUH<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">61</span></a>&#44; se refuerza su papel como herramienta de ayuda para la predicci&#243;n de infecci&#243;n bacteriana &#40;adem&#225;s de sepsis y bacteriemia&#41;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1-3&#44;15&#44;57-60</span></a>&#46; En este sentido&#44; aunque en Espa&#241;a ya se ha constatado que la disponibilidad de la PCT es real en m&#225;s del 70&#37; de los SUH&#44; solo en el 69&#37; de estos se usa habitualmente y de forma libre a demanda sin restricciones&#46; En el resto&#44; bien por falta de disponibilidad durante la tarde o la noche&#44; o bien por estar restringida su solicitud a otros especialistas &#40;medicina cr&#237;tica o infect&#243;logo&#44; por ejemplo&#41; o porque no est&#225; en la cartera de servicios del centro&#44; no se dispone de forma constante de esta determinaci&#243;n en todos los SUH<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1-3&#44;15</span></a>&#46; Este hecho es sin duda una mejora necesaria junto con la disponibilidad de uso de los antimicrobianos que constituyen las indicaciones de los programas de optimizaci&#243;n de antimicrobianos en los SUH<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Posiblemente&#44; en un futuro muy cercano&#44; en el propio triaje se dispondr&#225; de escalas o modelos autom&#225;ticos o electr&#243;nicos que seleccionar&#225;n a los pacientes con alta probabilidad de infecci&#243;n bacteriana y bacteriemia&#44; a los que se les aplicar&#225; los modelos diagn&#243;sticos y predictivos de infecci&#243;n bacteriana y bacteriemia&#44; as&#237; como de gravedad-mortalidad&#44; de forma que se pueda optimizar el diagn&#243;stico microbiol&#243;gico &#40;indicaci&#243;n de obtener HC y otras pruebas&#41; y las medidas terap&#233;uticas &#40;antibioterapia adecuada y precoz&#44; control del foco&#41;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1-3&#44;61&#44;62</span></a>&#46; Y&#44; de la misma forma&#44; otros marcadores emergentes como el MDW <span class="elsevierStyleItalic">&#40;Monocyte Distribution Width&#41;</span> o volumen de distribuci&#243;n de los monocitos<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">63</span></a> y modelos autom&#225;ticos &#40;como el que comprende el ligando inductor de apoptosis relacionado con el factor de necrosis tumoral &#91;TRAIL&#93;&#44; la prote&#237;na 10 inducida por interfer&#243;n gamma &#91;IP-10&#93; y la PCR<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">64</span></a> para diferenciar enfermedades bacterianas de virales&#41; tambi&#233;n ser&#225;n herramientas de ayuda diagn&#243;stica en los SUH&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; los autores quieren resaltar la necesidad e importancia de elaborar estudios desde los SUH con pacientes que acuden a ellos con procesos infecciosos comunitarios para confirmar o discutir otros resultados y recomendaciones que se hacen&#44; precisamente para los SUH&#44; sin evidencia cient&#237;fica originada sus pacientes y sus procesos<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">1-3&#44;8</span></a>&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">La principal limitaci&#243;n de esta revisi&#243;n sistem&#225;tica &#40;RS&#41; fue la dificultad para encontrar art&#237;culos exclusivos de pacientes adultos atendidos &#250;nicamente en SUH&#44; ya que la mayor&#237;a de los estudios encontrados durante el proceso de selecci&#243;n se centraron en entornos de hospitalizaci&#243;n&#44; Pediatr&#237;a o Medicina Intensiva&#46; Aunque se encontraron numerosos estudios que evaluaban la capacidad predictiva de la PCT para la infecci&#243;n bacteriana&#44; se debi&#243; descartar muchos de ellos debido a su alcance m&#225;s amplio<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">3&#44;15&#44;51-53</span></a>&#46; Otra limitaci&#243;n a considerar es que el sesgo de publicaci&#243;n no se tuvo en cuenta en el an&#225;lisis&#46; A pesar de estas limitaciones&#44; no hubo dificultades significativas relacionadas con las bases de datos consultadas ni con el idioma de los art&#237;culos&#44; que estaban disponibles tanto en ingl&#233;s como en espa&#241;ol&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusiones</span><p id="par0300" class="elsevierStylePara elsevierViewall">Esta revisi&#243;n muestra que la PCT tiene una precisi&#243;n diagn&#243;stica de infecci&#243;n considerable y representa una herramienta &#250;til para la sospecha de etiolog&#237;a bacteriana en aquellos pacientes atendidos en los SUH por los distintos procesos infecciosos comunitarios&#46; Adem&#225;s&#44; el punto de decisi&#243;n<span class="elsevierStyleHsp" style=""></span>&#62; 0&#44;25 &#40;0&#44;2-0&#44;3&#41; ng&#47;ml se ha posicionado como el m&#225;s adecuado&#44; estudiado y validado para predecir la existencia de infecci&#243;n bacteriana&#44; siempre de forma combinada con el juicio cl&#237;nico y otras variables independientes del proceso y del paciente&#46; De esta forma&#44; facilitar&#237;a la toma de decisi&#243;n de indicaci&#243;n de obtenci&#243;n de HC&#44; otros estudios microbiol&#243;gicos y la estrategia diagn&#243;stico-terap&#233;utica &#40;como la indicaci&#243;n de administrar antimicrobianos&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financiaci&#243;n</span><p id="par0305" class="elsevierStylePara elsevierViewall">Este manuscrito no ha recibido ninguna financiaci&#243;n por parte de ning&#250;n organismo ni p&#250;blico ni privado&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Responsabilidades &#233;ticas</span><p id="par0310" class="elsevierStylePara elsevierViewall">Los autores han confirmado el mantenimiento de la confidencialidad y respeto de los derechos de los pacientes&#44; as&#237; como su adhesi&#243;n a las normas internacionales&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0315" class="elsevierStylePara elsevierViewall">Todos los autores declaran no tener conflictos de inter&#233;s en relaci&#243;n con este art&#237;culo&#46; Ning&#250;n autor ha recibido compensaci&#243;n econ&#243;mica ni de ning&#250;n tipo por participar en este trabajo&#46;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">-</span><p id="par0320" class="elsevierStylePara elsevierViewall">AJJ ha participado en reuniones cient&#237;ficas organizadas por Bayer&#44; Sanofi&#44; Boehringer&#44; Esteve&#44; GSK&#44; Lilly&#44; MSD&#44; Pfizer&#44; Tedec Meiji&#44; Roche Diagnostics&#44; Thermo Fisher Scientific&#44; B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; AG&#44; ViroGates y Biomerieux&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">-</span><p id="par0325" class="elsevierStylePara elsevierViewall">LGGR ha participado en reuniones cient&#237;ficas organizadas por ViroGates&#44; Roche Diagnostics&#44; Gentian&#44; Radiometer&#44; Abionic&#44; Nova Biomedical y Snibe&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">-</span><p id="par0330" class="elsevierStylePara elsevierViewall">GMS declara la no existencia de conflictos de intereses&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">-</span><p id="par0335" class="elsevierStylePara elsevierViewall">DEG declara la no existencia de conflictos de intereses&#46;</p></li></ul></p></span></span>"
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              "titulo" => "Comparaci&#243;n y rendimientos diagn&#243;sticos de la procalcitonina seg&#250;n los distintos estudios y puntos de decisi&#243;n"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La atenci&#243;n de pacientes con sospecha de un proceso infeccioso en los servicios de Urgencias Hospitalarios &#40;SUH&#41; supone el 15&#37;-35&#37; de todas las atenciones diarias en estas &#225;reas asistenciales en Espa&#241;a y en Latinoam&#233;rica&#46; La administraci&#243;n precoz y adecuada del tratamiento antibi&#243;tico &#40;AB&#41; y la toma inmediata de otras decisiones diagn&#243;stico-terap&#233;uticas repercuten directamente en la supervivencia de los enfermos con infecci&#243;n bacteriana grave&#46; El objetivo principal de esta revisi&#243;n sistem&#225;tica es investigar la precisi&#243;n diagn&#243;stica de la PCT para predecir infecci&#243;n bacteriana en los pacientes adultos atendidos con sospecha cl&#237;nica de infecci&#243;n en el SUH&#44; as&#237; como analizar si los distintos estudios logran identificar un valor espec&#237;fico de PCT como el m&#225;s relevante desde el punto de vista diagn&#243;stico de decisi&#243;n cl&#237;nica que pueda recomendarse para la toma de decisiones en los SUH&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realiza una revisi&#243;n sistem&#225;tica siguiendo la normativa PRISMA en la base de datos de PubMed&#44; Web of Sciencie&#44; EMBASE&#44; Lilacs&#44; Cochrane&#44; Epistemonikos&#44; Tripdatabase y ClinicalTrials&#46;gov desde enero del 2005 hasta 31 mayo del 2023 sin restricci&#243;n de idiomas y utilizando una combinaci&#243;n de t&#233;rminos MESH&#58; &#171;Procalcitonin&#187;&#44; &#171;Infection&#47;Bacterial Infection&#47;Sepsis&#187;&#44; &#171;Emergencies&#47;Emergency&#47;Emergency Department&#187;&#44; &#171;Adults&#187; y &#171;Diagnostic&#187;&#46; Se incluyeron estudios de cohortes observacionales &#40;anal&#237;ticos de rendimiento diagn&#243;stico&#41;&#46; Para valorar la calidad del m&#233;todo empleado y el riesgo de sesgos de los art&#237;culos incluidos se utiliz&#243; la Newcastle-Ottawa Scale &#40;NOS&#41;&#46; No se realizaron t&#233;cnicas de metaan&#225;lisis&#44; pero los resultados se compararon narrativamente&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se identificaron un total de 1&#46;323 art&#237;culos&#44; de los cuales se analizaron finalmente 21 que cumpl&#237;an los criterios de inclusi&#243;n&#46; Los estudios incluyen 10&#46;333 pacientes con 4&#46;856 infecciones bacterianas &#40;47&#37;&#41;&#46; Ocho estudios fueron calificados de calidad alta&#44; 9 moderada y 4 baja&#46; El ABC-COR de todos los estudios se sit&#250;a desde 0&#44;68 &#40;IC del 95&#37;&#58; 0&#44;61-0&#44;72&#41; hasta 0&#44;99 &#40;IC del 95&#37;&#58;0&#44;98-1&#41;&#46; El valor de PCT 0&#44;2-0&#44;3 ng&#47;ml es el m&#225;s utilizado y propuesto hasta en 12<span class="elsevierStyleHsp" style=""></span>de los trabajos que se incluyen en esta revisi&#243;n cuyo rendimiento medio estimado es de un ABC-COR de 0&#44;79&#46; Si solo se tienen en cuenta los resultados de los 5 estudios de alta calidad que utilizan un punto de corte 0&#44;2-0&#44;3 ng&#47;ml de PCT&#44; el resultado medio estimado del ABC-COR es 0&#44;78 con Se&#58; 69&#37; y Es&#58; 76&#37;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La PCT tiene una precisi&#243;n diagn&#243;stica de infecci&#243;n bacteriana considerable en los pacientes atendidos en los SUH por los distintos procesos infecciosos&#46; El punto de corte 0&#44;25 &#40;0&#44;2-0&#44;3&#41; ng&#47;ml se ha posicionado como el m&#225;s adecuado para predecir la existencia de infecci&#243;n bacteriana y se puede utilizar como ayuda para descartar esta razonablemente&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introducci&#243;n y objetivo"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todo"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction and objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The care of patients with a suspected infectious process in hospital emergency departments &#40;ED&#41; accounts for 15&#37;-35&#37; of all daily care in these healthcare areas in Spain and Latin America&#46; The early and adequate administration of antibiotic treatment &#40;AB&#41; and the immediate making of other diagnostic-therapeutic decisions have a direct impact on the survival of patients with severe bacterial infection&#46; The main objective of this systematic review is to investigate the diagnostic accuracy of PCT to predict bacterial infection in adult patients treated with clinical suspicion of infection in the ED&#44; as well as to analyze whether the different studies manage to identify a specific value of PCT as the most relevant from the diagnostic point of view of clinical decision that can be recommended for decision making in ED&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A systematic review is carried out following the PRISMA regulations in the database of PubMed&#44; Web of Science&#44; EMBASE&#44; Lilacs&#44; Cochrane&#44; Epistemonikos&#44; Tripdatabase and ClinicalTrials&#46;gov from January 2005 to May 31&#44; 2023 without language restriction and using a combination of MESH terms&#58; &#8220;Procalcitonin&#8221;&#44; &#8220;Infection&#47; Bacterial Infection&#47; Sepsis&#8221;&#44; &#8220;Emergencies&#47; Emergency&#47; Emergency Department&#8221;&#44; &#8220;Adults&#8221; and &#8220;Diagnostic&#8221;&#46; Observational cohort studies &#40;diagnostic performance analyses&#41; were included&#46; The Newcastle-Ottawa Scale &#40;NOS&#41; was used to assess the quality of the method used and the risk of bias of the included articles&#46; No meta-analysis techniques were performed&#44; but results were compared narratively&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 1&#44;323 articles were identified&#44; of which 21 that met the inclusion criteria were finally analyzed&#46; The studies include 10&#44;333 patients with 4&#44;856 bacterial infections &#40;47&#37;&#41;&#46; Eight studies were rated as high&#44; 9 as moderate&#44; and 4 as low&#46; The AUC-ROC of all studies ranges from 0&#46;68 &#40;95&#37; CI&#58; 0&#46;61-0&#46;72&#41; to 0&#46;99 &#40;95&#37; CI&#58; 0&#46;98-1&#41;&#46; The value of PCT 0&#46;2-0&#46;3 ng&#47;ml is the most used and proposed in up to 12<span class="elsevierStyleHsp" style=""></span>of the works included in this review whose average estimated performance is an AUC-ROC of 0&#46;79&#46; If only the results of the 5 high-quality studies using a cut-off point of 0&#46;2-0&#46;3 ng&#47;ml PCT are taken into account&#44; the estimated mean AUC-COR result is 0&#46;78 with Se&#58;69&#37; and Es&#58;76&#37;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">PCT has considerable diagnostic accuracy for bacterial infection in patients treated in ED for different infectious processes&#46; The cut-off point of 0&#46;25 &#40;0&#46;2-0&#46;3&#41; ng&#47;ml has been positioned as the most appropriate to predict the existence of bacterial infection and can be used to help reasonably rule it out&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;Sexo&#58;hombres &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tipo paciente&#47;proceso&#47;foco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37; infecci&#243;n bacteriana confirmada del total de la muestra&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ABC-CORIC del 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Se &#40;&#37;&#41;IC del 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Es &#40;&#37;&#41;IC del 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VPP &#40;&#37;&#41;IC del 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VPN &#40;&#37;&#41;IC del 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ProcalcitoninaPunto corteReferecia en el estudio&#40;ng&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">T&#233;cnica-metodolog&#237;a valoraci&#243;n de las concentraciones de procalcitonina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aikawa et al&#46;Jap&#243;n2005<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivomultic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mediana 4258&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de infecci&#243;n bacteriana frente a no bacteriana<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;84</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">64&#44;4</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">86&#44;0</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">82&#44;9</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">69&#44;8</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;5 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensayo inmunoluminim&#233;trico &#40;prueba LUMI PCT&#59; B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; Diagnostica&#44; Berl&#237;n&#44; Alemania&#41;Sensibilidad 0&#44;09 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rai et al&#46;Francia2007<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivomultic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 35 &#40;DE 15&#41;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de infecci&#243;n&#47;meningitis bacteriana frente a no bacteriana<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;98</span><span class="elsevierStyleBold">&#40;0&#44;83-1&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">87</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">100</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">100</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">99</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">2&#44;13 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sistema KRYPTOR por inmunofluorescencia &#40;B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; AG&#44; Hennigsdorf&#47;Berl&#237;n&#44; Alemania&#41;Sensibilidad 0&#44;07 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#252;ller et al&#46;Suiza2007<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">545&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 67 &#40;DE 18&#41;63&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de neumon&#237;a bacteriana frente a otras causas de disnea<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;88</span><span class="elsevierStyleBold">&#40;0&#44;84-0&#44;93&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90nd<span class="elsevierStyleBold">74</span><span class="elsevierStyleBold">nd</span>57nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59nd<span class="elsevierStyleBold">85</span><span class="elsevierStyleBold">Nd</span>93nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ndnd<span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ndnd<span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1 ng&#47;ml<span class="elsevierStyleBold">0&#44;25 ng&#47;ml</span>0&#44;5 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sistema KRYPTOR por inmunofluorescencia &#40;B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; AG&#44; Hennigsdorf&#47;Berl&#237;n&#44; Alemania&#41;Sensibilidad 0&#44;06 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hausfater et al&#46;Francia2007<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#40;DE 21&#41;55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pacientes con fiebre y sospecha de infecci&#243;n bacteriana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;77</span><span class="elsevierStyleBold">&#40;0&#44;70-0&#44;82&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#40;85-94&#41;<span class="elsevierStyleBold">77</span><span class="elsevierStyleBold">&#40;70-82&#41;</span>63&#40;55-70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#40;22-43&#41;<span class="elsevierStyleBold">59</span><span class="elsevierStyleBold">&#40;48-70&#41;</span>79&#40;68-87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#40;68-80&#41;<span class="elsevierStyleBold">80</span><span class="elsevierStyleBold">&#40;74-86&#41;</span>87&#40;80-92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#40;47-74&#41;<span class="elsevierStyleBold">54</span><span class="elsevierStyleBold">&#40;43-64&#41;</span>49&#40;40-58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1 ng&#47;ml<span class="elsevierStyleBold">0&#44;2 ng&#47;ml</span>0&#44;5 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sistema KRYPTOR por inmunofluorescencia &#40;B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; AG&#44; Hennigsdorf&#47;Berl&#237;n&#44; Alemania&#41;Sensibilidad 0&#44;06 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">De Kruif et al&#46;The Netherlands2010<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">211&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mediana 64 &#40;RIC 46-74&#41;55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pacientes con fiebre y sospecha de infecci&#243;n bacteriana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;73</span><span class="elsevierStyleBold">&#40;0&#44;63-0&#44;82&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77nd<span class="elsevierStyleBold">66</span><span class="elsevierStyleBold">nd</span>53nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38nd<span class="elsevierStyleBold">68</span><span class="elsevierStyleBold">nd</span>85nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73nd<span class="elsevierStyleBold">81</span><span class="elsevierStyleBold">nd</span>89nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43nd<span class="elsevierStyleBold">48</span><span class="elsevierStyleBold">nd</span>46nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1 ng&#47;ml<span class="elsevierStyleBold">0&#44;25 ng&#47;ml</span>0&#44;50 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensayo inmunoan&#225;lisis cuantitativo de electroquimioluminiscencia &#40;B&#46;R&#46;A&#46;H&#46;M&#46;S&#46;&#44; Hennigsdorf&#44; Alemania&#41;Sensibilidad 0&#44;007 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Viallon et al&#46;Francia2011<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">254&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 37 &#40;DE 19&#41;49&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pacientes con sospecha de meningitis bacteriana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;99</span><span class="elsevierStyleBold">&#40;0&#44;99-1&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">97</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">100</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">97</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">100</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;28 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sistema KRYPTOR por inmunofluorescencia &#40;B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; AG&#44; Hennigsdorf&#47;Berl&#237;n&#44; Alemania&#41;Sensibilidad 0&#44;06 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tudela et al&#46;Espa&#241;a2012<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">412&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mediana 69 &#40;RIC 54-78&#41;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de infecci&#243;n bacteriana<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;68</span><span class="elsevierStyleBold">&#40;0&#44;61-0&#44;76&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">56</span><span class="elsevierStyleBold">46-65</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">73</span><span class="elsevierStyleBold">62-81</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">72</span><span class="elsevierStyleBold">61-80</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">57</span><span class="elsevierStyleBold">48-66</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;4 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sistema KRYPTOR por inmunofluorescencia &#40;B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; AG&#44; Hennigsdorf&#47;Berl&#237;n&#44; Alemania&#41;Sensibilidad 0&#44;06 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Liu et al&#46;China2013<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">859&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mediana 71 &#40;RIC 58-78&#41;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de infecci&#243;n bacteriana en pacientes con criterios de sepsis<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;72</span><span class="elsevierStyleBold">&#40;0&#44;68-0&#44;77&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">60</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">78</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">93</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">28</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;25 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sistema BioMerieux Mini VIDAS analizador inmunoan&#225;lisis &#40;Block Scientific&#44; Bohemia&#44; NY&#44; EE&#46; UU&#46;&#41;Sensibilidad 0&#44;05 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ulla et al&#46;Italia2013<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoMultic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 6561&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de infecci&#243;n bacteriana en pacientes con criterios de sepsis<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;87</span><span class="elsevierStyleBold">&#40;0&#44;82-0&#44;92&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">89</span><span class="elsevierStyleBold">&#40;81-95&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">76</span><span class="elsevierStyleBold">&#40;65-85&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;18 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;todo&#58; inmunoan&#225;lisis cuantitativo de electroquimioluminiscencia ELECSYS &#40;B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; PCT&#41;Sensibilidad&#58; 0&#44;02 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jekarl et al&#46;2013Corea del Sur<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">177&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 51&#40;DE 22&#41;49&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de infecci&#243;n bacteriana en pacientes con criterios de sepsis<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;83</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">74</span><span class="elsevierStyleBold">&#40;63-84&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">87</span><span class="elsevierStyleBold">&#40;79-93&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">69</span><span class="elsevierStyleBold">&#40;57-79&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">82</span><span class="elsevierStyleBold">&#40;71-90&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;23 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;todo&#58; inmunoan&#225;lisis cuantitativo de electroquimioluminiscencia ELECSYS &#40;B&#46;R&#46;A&#46;H&#46;M&#46;S&#44; PCT&#41;&#46; Sensibilidad&#58; 0&#44;01 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jaimes et al&#46;Colombia2013<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 51 &#40;DE 20&#41;49&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de infecci&#243;n bacteriana en pacientes con criterios de sepsis<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;70</span><span class="elsevierStyleBold">&#40;0&#44;67-0&#44;73&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">67</span><span class="elsevierStyleBold">&#40;63-71&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">66</span><span class="elsevierStyleBold">&#40;60-72&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;27 ng &#47; ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sistema BioMerieux VIDAS analizador inmunoan&#225;lisis &#40;Biomeriux&#44; Francia&#41;Sensibilidad 0&#44;05 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shen et al&#46;China2015<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">38</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 48 &#40;DE 19&#41;44&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pacientes con sospecha de meningitis bacteriana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;96</span><span class="elsevierStyleBold">&#40;0&#44;93-1&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">87</span><span class="elsevierStyleBold">&#40;73-95&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">100</span><span class="elsevierStyleBold">&#40;95-100&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;88 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ensayo inmunoluminim&#233;trico &#40;prueba LUMI PCT&#59; B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; Diagnostica&#44; Berl&#237;n&#44; Alemania&#41;Sensibilidad 0&#44;09 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heining et al&#46;Alemania2016<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">172&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 70 &#40;DE 15&#41;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de neumon&#237;a bacteriana frente a otras causas de disnea<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;74</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">45</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">85</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">38</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">88</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;25 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sistema KRYPTOR por inmunofluorescencia &#40;B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; AG&#44; Hennigsdorf&#47;Berl&#237;n&#44; Alemania&#41;Sensibilidad 0&#44;06 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Morales Casado et al&#46;Espa&#241;a2016<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">40</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 44 &#40;DE 21&#41;67&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pacientes con sospecha de meningitis bacteriana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;99</span><span class="elsevierStyleBold">&#40;0&#44;98-1&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">95</span><span class="elsevierStyleBold">&#40;82-99&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">100</span><span class="elsevierStyleBold">&#40;89-100&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">100</span><span class="elsevierStyleBold">&#40;90-100&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">94</span><span class="elsevierStyleBold">&#40;80-99&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;74 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCT por inmunoan&#225;lisis cuantitativo de electroquimioluminiscencia &#40;Elecsys B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; PCT&#41; con una sensibilidad de 0&#44;02 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garc&#237;a de Guadiana et al&#46;2017Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">41</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">223&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mediana 69 &#40;RIC 52-78&#41;58&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pacientes con sospecha de infecci&#243;n bacteriana<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;91</span><span class="elsevierStyleBold">&#40;0&#44;86-0&#44;94&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">77</span><span class="elsevierStyleBold">&#40;71-83&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">96</span><span class="elsevierStyleBold">&#40;78-99&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;22 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;todo&#58; inmunoan&#225;lisis cuantitativo de electroquimioluminiscencia &#40;Cobas e411&#59; Roche Diagnostics&#44; Mannheim&#44; Alemania&#41;Sensibilidad 0&#44;06 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Morales-Casado et al&#46;Espa&#241;a2017<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">42</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 44 &#40;DE 22&#41;59&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pacientes con sospecha de meningitis bacteriana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;98 &#40;0&#44;95-1&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">98</span><span class="elsevierStyleBold">&#40;89-100&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">89</span><span class="elsevierStyleBold">&#40;80-95&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">98</span><span class="elsevierStyleBold">&#40;92-100&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">85</span><span class="elsevierStyleBold">&#40;73-93&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;8 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCT por inmunoan&#225;lisis cuantitativo de electroquimioluminiscencia &#40;Elecsys B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; PCT&#41; con una sensibilidad de 0&#44;02 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garc&#237;a de Guadiana et al&#46;2018Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 70 &#40;DE 19&#41;59&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pacientes con sospecha de infecci&#243;n bacteriana<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;84</span><span class="elsevierStyleBold">&#40;0&#44;77-0&#44;90&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">80</span><span class="elsevierStyleBold">&#40;66-90&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">77</span><span class="elsevierStyleBold">&#40;64-88&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">76</span><span class="elsevierStyleBold">&#40;62-87&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">80</span><span class="elsevierStyleBold">&#40;67-90&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">1&#44;30 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;todo&#58; inmunoan&#225;lisis cuantitativo de electroquimioluminiscencia &#40;Cobas e411&#59; Roche Diagnostics&#44; Mannheim&#44; Alemania&#41;Sensibilidad 0&#44;06 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Levine et al&#46;Estados Unidos2019<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">44</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">293&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RetrospectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 69 &#40;DE 16&#41;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pacientes con sospecha de ITU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;72</span><span class="elsevierStyleBold">&#40;0&#44;64-0&#44;79&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">81</span><span class="elsevierStyleBold">nd</span><span class="elsevierStyleBold">67</span><span class="elsevierStyleBold">nd</span><span class="elsevierStyleBold">50</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">49</span><span class="elsevierStyleBold">nd</span><span class="elsevierStyleBold">63</span><span class="elsevierStyleBold">nd</span><span class="elsevierStyleBold">77</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">24</span><span class="elsevierStyleBold">nd</span><span class="elsevierStyleBold">26</span><span class="elsevierStyleBold">nd</span><span class="elsevierStyleBold">30</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">93</span><span class="elsevierStyleBold">nd</span><span class="elsevierStyleBold">91</span><span class="elsevierStyleBold">nd</span><span class="elsevierStyleBold">89</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;1 ng&#47;ml</span><span class="elsevierStyleBold">0&#44;25 ng&#47;ml</span><span class="elsevierStyleBold">0&#44;50 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sistema KRYPTOR &#40;B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; AG&#44; Hennigsdorf&#47;Berl&#237;n&#44; Alemania&#41;Sensibilidad 0&#44;06 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Contenti et al&#46;Francia2019<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">45</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">359&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 70 &#40;DE 18&#41;56&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de infecci&#243;n bacteriana en pacientes con criterios de sepsis<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;71</span><span class="elsevierStyleBold">&#40;0&#44;66-0&#44;76&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">70</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">59</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">79</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">47</span><span class="elsevierStyleBold">nd</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;25 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCT por inmunoan&#225;lisis cuantitativo de electroquimioluminiscencia &#40;Elecsys B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; PCT&#41; con una sensibilidad de 0&#44;02 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Christensen et al&#46;Noruega2022<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">46</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">391&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoUnic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 68 &#40;DE 19&#41;57&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de infecci&#243;n bacteriana<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;84</span><span class="elsevierStyleBold">&#40;0&#44;80-0&#44;88&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#40;78-88&#41;<span class="elsevierStyleBold">68</span><span class="elsevierStyleBold">&#40;61-73&#41;</span>54&#40;47-60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#40;60-75&#41;<span class="elsevierStyleBold">87</span><span class="elsevierStyleBold">&#40;80-92&#41;</span>95&#40;90-98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80nd<span class="elsevierStyleBold">89</span><span class="elsevierStyleBold">nd</span>95nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73nd<span class="elsevierStyleBold">64</span><span class="elsevierStyleBold">nd</span>57nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1 ng&#47;ml<span class="elsevierStyleBold">0&#44;22 ng&#47;ml</span>0&#44;4 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sistema Roche Cobas 8000 e801 Elecsys B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; PCT &#40;Termo Fisher&#41;Sensibilidad 0&#44;1 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Rubio-Diaz et al&#46;Espa&#241;a2022<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;439&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProspectivoMultic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Media 67 &#40;DE 18&#41;59&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de infecci&#243;nbacteriana<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">46&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;70</span><span class="elsevierStyleBold">&#40;0&#44;68-0&#44;72&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">44</span><span class="elsevierStyleBold">&#40;42-46&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">86</span><span class="elsevierStyleBold">&#40;84-88&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">75</span><span class="elsevierStyleBold">&#40;73-77&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">65</span><span class="elsevierStyleBold">&#40;63-67&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;5 ng&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#233;todo de inmunoan&#225;lisis cuantitativo de electroquimioluminiscencia ELECSYS &#40;B&#46;R&#46;A&#46;H&#46;M&#46;S&#46; PCT&#41;&#44; sensibilidad de 0&#44;02 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Puntuaci&#243;nTotal&#40;riesgo de sesgo&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;medio&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Muller et al&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Tudela et al&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;medio&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Liu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;bajo&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ulla et al&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Heining et al&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Morales Casado et al&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">40</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;bajo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garc&#237;a de Guadiana et al&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">41</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;medio&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Morales-Casado et al&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">42</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;bajo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garc&#237;a de Guadiana et al&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;medio&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Levine et al&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">44</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;medio&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Contenti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">45</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;medio&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Christensen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">46</span></a>&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ABC-COR&#58; &#225;rea bajo la curva de la caracter&#237;stica operativa del receptor&#59; Es&#58; especificidad&#59; IC 95&#37;&#58; intervalo de confianza al 95&#37;&#59; nd&#58; no disponible&#59; Se&#58; sensibilidad&#59; VPN&#58; valor predictivo negativo&#59; VPP&#58; valor predictivo positivo&#46;</p>"
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                  \t\t\t\t">De Kruif et al&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;25 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Viallon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Liu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jaimes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;70&#40;0&#44;67-0&#44;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67&#40;63-71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66&#40;60-72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;27 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Heining et al&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;74nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45nd&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">85nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">88nd&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;25 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Garc&#237;a de Guadiana et al&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">41</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;91&#40;0&#44;86-0&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">77&#40;71-83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">96&#40;78-99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">nd&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;22 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Levine et al&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">44</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;72&#40;0&#44;64-0&#44;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">67nd&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">63nd&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26nd&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">91nd&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;25 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Contenti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">45</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;71&#40;0&#44;66-0&#44;76&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">70nd&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">59nd&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">79nd&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Christensen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">46</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;84&#40;0&#44;80-0&#44;88&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68&#40;61-73&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">87&#40;80-92&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;22 ng&#47;ml&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n del rendimiento diagn&#243;stico de infecci&#243;n bacteriana de los estudios que definieron el punto de decisi&#243;n de procalcitonina de 0&#44;2-0&#44;3 ng&#47;ml</p>"
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