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Procalcitonin to Reduce the Number of Unnecessary Cystographies in Children with a Urinary Tract Infection: A European Validation Study

2006; Elsevier BV; Volume: 150; Issue: 1 Linguagem: Inglês

10.1016/j.jpeds.2006.08.066

1097-6833

Sandrine Leroy, Carla Romanello, Annick Galetto-Lacour, Vladislav Smolkin, Bartosz Korczowski, Carlos Rodrigo, David Tuerlinckx, Vincent Gajdos, Florence Moulin, Marzia Contardo, Alain Gervaix, Raphaël Halevy, B Duhl, Cristina Prat, Thierry Vander Borght, L. Foix‐L’Hélias, François Dubos, D Gendrel, Gérard Bréart, Martin Chalumeau,

Bladder and Urothelial Cancer Treatments

Objective To validate high serum procalcitonin (PCT) as a predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI). Study design This secondary analysis of prospective hospital-based cohort studies included children ages 1 month to 4 years with a first febrile UTI. Results Of the 398 patients included in 8 centers in 7 European countries, 25% had VUR. The median PCT concentration was significantly higher in children with VUR than in those without: 1.6 versus 0.7 ng/mL (P = 10−4). High PCT (≥0.5 ng/mL) was associated with VUR (OR: 2.3; 95% CI, 1.3 to 3.9; P = 10−3). After adjustment for all cofactors, the association remained significant (OR: 2.5; 95% CI, 1.4 to 4.4; P = 10−3). The strength of the relation increased with the grade of reflux (P = 10−5). The sensitivity of procalcitonin was 75% (95% CI, 66 to 83) for all-grade VUR and 100% (95% CI, 81 to 100) for grade ≥4 VUR, both with 43% specificity (95% CI, 37 to 48). Conclusions High PCT is a strong, independent and now validated predictor of VUR that can be used to identify low-risk patients and thus avoid one third of the unnecessary cystourethrographies in children with a first febrile UTI. To validate high serum procalcitonin (PCT) as a predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI). This secondary analysis of prospective hospital-based cohort studies included children ages 1 month to 4 years with a first febrile UTI. Of the 398 patients included in 8 centers in 7 European countries, 25% had VUR. The median PCT concentration was significantly higher in children with VUR than in those without: 1.6 versus 0.7 ng/mL (P = 10−4). High PCT (≥0.5 ng/mL) was associated with VUR (OR: 2.3; 95% CI, 1.3 to 3.9; P = 10−3). After adjustment for all cofactors, the association remained significant (OR: 2.5; 95% CI, 1.4 to 4.4; P = 10−3). The strength of the relation increased with the grade of reflux (P = 10−5). The sensitivity of procalcitonin was 75% (95% CI, 66 to 83) for all-grade VUR and 100% (95% CI, 81 to 100) for grade ≥4 VUR, both with 43% specificity (95% CI, 37 to 48). High PCT is a strong, independent and now validated predictor of VUR that can be used to identify low-risk patients and thus avoid one third of the unnecessary cystourethrographies in children with a first febrile UTI.