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Diagnostic performance of procalcitonin for hospitalised children with acute pyelonephritis presenting to the paediatric emergency department
  1. Shan-Ming Chen1,2,
  2. Hung-Ming Chang3,
  3. Tung-Wei Hung2,4,
  4. Yu-Hua Chao1,
  5. Jeng-Dau Tsai1,2,
  6. Ko-Huang Lue1,5,
  7. Ji-Nan Sheu1,5
  1. 1Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
  2. 2Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
  3. 3Department of Anatomy, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
  4. 4Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
  5. 5Department of Pediatrics, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
  1. Correspondence to Dr Ji-Nan Sheu, Department of Pediatrics, Chung Shan Medical University Hospital, No. 110, Section, 1, Jianguo North Road, Taichung 402, Taiwan; cshy098{at}csh.org.tw

Abstract

Objectives Urinary tract infection (UTI) is a common bacterial infection in children that can result in permanent renal damage. This study prospectively assessed the diagnostic performance of procalcitonin (PCT) for predicting acute pyelonephritis (APN) among children with febrile UTI presenting to the paediatric emergency department (ED).

Methods Children aged ≤10 years with febrile UTI admitted to hospital from the paediatric ED were prospectively studied. Blood PCT, C reactive protein (CRP) and white blood cell (WBC) count were measured in the ED. Sensitivity, specificity, predictive values, multilevel likelihood ratios, receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess quantitative variables for diagnosing APN.

Results The 136 enrolled patients (56 boys and 80 girls; age range 1 month to 10 years) were divided into APN (n=87) and lower UTI (n=49) groups according to 99mTc-dimercaptosuccinic acid scan results. The cut-off value for maximum diagnostic performance of PCT was 1.3 ng/ml (sensitivity 86.2%, specificity 89.8%). By multivariate regression analysis, only PCT and CRP were retained as significant predictors of APN. Comparing ROC curves, PCT had a significantly greater area under the curve than CRP, WBC count and fever for differentiating between APN and lower UTI.

Conclusions PCT has better sensitivity and specificity than CRP and WBC count for distinguishing between APN and lower UTI. PCT is a valuable marker for predicting APN in children with febrile UTI. It may be considered in the initial investigation and therapeutic strategies for children presenting to the ED.

  • Procalcitonin
  • acute pyelonephritis
  • emergency department
  • children
  • febrile urinary tract infection
  • paediatrics
  • paediatric emergency medicine
  • renal

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Footnotes

  • Funding This work was supported by grants from Chung Shan Medical University Hospital (CSH-2010-C-009).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board of Chung Shan Medical University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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