Cytokines in urine in elderly subjects with acute cystitis and asymptomatic bacteriuria.
OBJECTIVE
Searching for useful diagnostic tools to discriminate between asymptomatic bacteriuria (ASB) and acute cystitis, this study compared urinary levels of cytokines/chemokines and leukocyte esterase in three groups of elderly subjects; those with acute cystitis, those with ASB, and those without bacteriuria.


METHODS
Comparative laboratory.


METHODS
Primary care.


METHODS
A total of 16 patients with acute cystitis, 24 subjects with ASB, and 20 controls without bacteriuria, all of whom were aged 80 or over.


METHODS
Urinary levels of IL-1 beta, TNF-alpha, IL-12, IL-18, CXCL1 (GRO-alpha), CXCL8 (IL-8), CCL2 (MCP-1), IL-6, IL-10, and leukocyte esterase.


RESULTS
Urinary levels of CXCL1, CXCL8, and IL-6 were significantly higher in acute cystitis patients than in the ASB group. The sensitivities and specificities for CXCL8, IL-6, and leukocyte esterase to discriminate between acute cystitis and ASB were 63% (95% CI 36-84) and 96% (95% CI 77-100) (cut-off > 285 pg/mg creatinine), 81% (95% CI 54-95) and 96% (95% CI 77-100) (cut-off > 30 pg/mg creatinine), and 88% (95% CI 60-98) and 79% (95% CI 57-92) (cut-off > 2, on a scale of 0-4), respectively.


CONCLUSIONS
The results indicate that measurement of urinary cytokines, and also leukocyte esterase, when using a cut-off value > 2, could be useful in clinical practice to discriminate between symptomatic and asymptomatic urinary tract infections in the elderly. A combination of IL-6 and leukocyte esterase could be even more useful. This needs to be evaluated in prospective studies on the diagnosis and treatment of urinary tract infections in an elderly population.
Rodhe
Nils
N
Centre for Clinical Research, Dalarna, Sweden. nils.rodhe@ltdalarna.se
Löfgren
Sture
S
Strindhall
Jan
J
Matussek
Andreas
A
Mölstad
Sigvard
S
D000369:Aged, 80 and over; D001437:Bacteriuria / Q000175:diagnosis / Q000652:urine*; D002265:Carboxylic Ester Hydrolases / Q000652:urine*; D003404:Creatinine / Q000652:urine; D003556:Cystitis / Q000175:diagnosis / Q000652:urine*; D016207:Cytokines / Q000652:urine*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000652:urine; D008297:Male; D012680:Sensitivity and Specificity
D016207:Cytokines; D015850:Interleukin-6; D003404:Creatinine; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases