title: A single procalcitonin level does not predict adverse outcomes of women with pyelonephritis.
abstract: OBJECTIVE
  Predicting medical outcomes for pyelonephritis in women is difficult, leading to unnecessary hospitalization. Unlike other serious infectious diseases, high procalcitonin (PCT) level has never been associated with 28-d adverse medical outcomes in women with pyelonephritis. Therefore, we sought to determine the accuracy of PCT in discriminating between pyelonephritis with adverse medical outcome (PAMO) and pyelonephritis without adverse medical outcome (PWAMO).
  
  
  METHODS
  Adult women with pyelonephritis presenting to the emergency department of a French tertiary care hospital were consecutively included. Those patients who developed adverse medical outcomes during a 28-d follow-up period were identified as having PAMO. Baseline characteristics and PCT level were compared between patients with PAMO and PWAMO.
  
  
  RESULTS
  Eleven women (19.0%) had PAMO and 47 (81%) had PWAMO. The median PCT level was higher in PAMO compared with PWAMO 0.51 ng/ml (IQR: 0.04-3.8) and 0.08 ng/ml (IQR: 0.01-1.0), but this difference was not statistically significant (p=0.07). We failed to find a threshold value for PCT that discriminated between PAMO and PWAMO (ROC, AUC=0.67 [95%CI, 0.51-0.86]). All but one subject with PAMO had either a PCT level >0.1 ng/ml or an underlying genitourinary abnormality by radiographic testing.
  
  
  CONCLUSIONS
  A single PCT level was a poor predictor of 28-d adverse medical outcomes in women with pyelonephritis treated in the emergency department. Prediction based on underlying genitourinary abnormality by radiographic testing in addition to the PCT level should be investigated in future studies.
authors.affiliation: Emergency Department of Henri Mondor Hospital (AP-HP), 51 avenue du Maréchal Delattre de Tassigny, 94010 Créteil Cedex, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
authors.forename: Bertrand
authors.initials: B
authors.lastname: Renaud
authors.forename: Stéphane
authors.initials: S
authors.lastname: Moutereau
authors.forename: Alfred
authors.initials: A
authors.lastname: N'Gako
authors.forename: Mirna
authors.initials: M
authors.lastname: Salloum
authors.forename: Marie Jeanne
authors.initials: MJ
authors.lastname: Calmettes
authors.forename: Jérôme
authors.initials: J
authors.lastname: Hervé
authors.forename: Cyril
authors.initials: C
authors.lastname: Boraud
authors.forename: Aline
authors.initials: A
authors.lastname: Santin
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Grégo
authors.forename: François
authors.initials: F
authors.lastname: Braconnier
authors.forename: Eric
authors.initials: E
authors.lastname: Roupie
mesh_terms: D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D011704:Pyelonephritis / Q000097:blood / Q000145:classification / Q000150:complications* / Q000175:diagnosis; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide