Procalcitonin to reduce the number of unnecessary cystographies in children with a urinary tract infection: a European validation study.
OBJECTIVE
To validate high serum procalcitonin (PCT) as a predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI).


METHODS
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 (> or =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 > or =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.
Leroy
Sandrine
S
Clinical Epidemiological Unit-Department of Pediatrics, Saint-Vincent-de-Paul Hospital, AP-HP, Université Paris-Descartes, Paris, France.
Romanello
Carla
C
Galetto-Lacour
Annick
A
Smolkin
Vladislav
V
Korczowski
Bartosz
B
Rodrigo
Carlos
C
Tuerlinckx
David
D
Gajdos
Vincent
V
Moulin
Florence
F
Contardo
Marzia
M
Gervaix
Alain
A
Halevy
Raphaël
R
Duhl
Barbara
B
Prat
Cristina
C
Borght
Thierry Vander
TV
Foix-l'Hélias
Laurence
L
Dubos
François
F
Gendrel
Dominique
D
Bréart
Gérard
G
Chalumeau
Martin
M
D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016001:Confidence Intervals; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006023:Glycoproteins; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D014552:Urinary Tract Infections / Q000097:blood* / Q000000981:diagnostic imaging*; D014567:Urography / Q000706:statistics & numerical data*
C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide