Serum procalcitonin for prediction of renal parenchymal involvement in children with urinary tract infections: a meta-analysis of prospective clinical studies.
OBJECTIVE
To determine by meta-analysis whether serum procalcitonin (PCT) is a useful marker of acute renal parenchymal involvement (RPI) in children with culture-proven urinary tract infection (UTI), as diagnosed by acute-phase DMSA (Tc-99m dimercaptosuccinic acid) renal scintigraphy.


METHODS
We searched PubMed and the Cochrane Central Register of Controlled Trials for prospective studies involving children with culture-proven UTIs. Additional eligibility criteria were measurement of serum PCT at presentation and performance of DMSA scintigraphy within 14 days.


RESULTS
Overall, 10 studies eligible for inclusion, involving a total of 627 children, were identified. Half of these studies evaluated children with a first episode of UTI; 8 involved children with febrile UTIs. Using a cutoff value of 0.5 to 0.6 ng/mL, the pooled diagnostic odds ratio of serum PCT for UTI with RPI was 14.25 (95% confidence interval, 4.70 to 43.23). High statistical between-study heterogeneity that could mainly be attributed to 2 studies was observed. The remaining 8 studies uniformly favored PCT use.


CONCLUSIONS
In children with culture-proven UTI, a serum PCT value >0.5 ng/mL predicts reasonably well the presence of RPI, as evidenced by DMSA scintigraphy. PCT may aid in the identification of children with UTI, necessitating more intense evaluation and management.
Mantadakis
Elpis
E
Department of Pediatrics, Democritus University of Thrace and University General Hospital of Alexandroupolis, Thrace, Greece.
Plessa
Eleni
E
Vouloumanou
Evridiki K
EK
Karageorgopoulos
Drosos E
DE
Chatzimichael
Athanasios
A
Falagas
Mathew E
ME
D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009399:Nephrons / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014552:Urinary Tract Infections / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology
C000606589:CALCA protein, human; D011498:Protein Precursors; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide