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Accurate diagnosis of acute pyelonephritis: How helpful is procalcitonin?

2006; Lippincott Williams & Wilkins; Volume: 27; Issue: 9 Linguagem: Inglês

10.1097/01.mnm.0000230072.61941.71

1473-5628

Ayfer Gür Güven, Halis Z. Kazdal, Mustafa Koyun, Funda Aydn, F. Gungor, Sema Akman, Yunus Emre Baysal,

Urinary Tract Infections Management

This prospective study aimed to investigate the diagnostic value of serum procalcitonin levels in children with acute pyelonephritis documented by Tc-dimercaptosuccinic acid (DMSA) scintigraphy.We compared the symptoms and laboratory findings of fever, vomiting, abdominal/flank pain, leukocyte count, serum C-reactive protein and procalcitonin levels with the results of the DMSA scan obtained within the first 72 h after referral in children who were diagnosed as having acute pyelonephritis. Thirty-three children (31 female and two male) aged 1-11 years (mean 4.42 years) were enrolled in this prospective study.Twenty-one of 33 patients (64%) had positive DMSA scans. On the scans obtained after 6 months, five of 21 patients (23.8%) had renal scars. No correlation was found between clinical and laboratory parameters, alone or combined with each other, and positive DMSA scans. Serum procalcitonin levels were 0.767+/-0.64 and 1.23+/-1.17 ng . ml in children with normal and positive DMSA scans, respectively. The cut-off value for procalcitonin using receiver operating characteristic analysis was 0.9605 ng . ml, while sensitivity and specificity were 86.4% and 36.4%, respectively. However, if the cut-off value was chosen as 2 ng . ml, the sensitivity increased to 100% while specificity did not change markedly.The serum procalcitonin test, like other commonly used laboratory parameters, e.g. serum C-reactive protein and white blood cell count, was inadequate in distinguishing renal parenchymal involvement in acute febrile urinary tract infections.