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.
Department of Pediatrics, Democritus University of Thrace and University General Hospital of Alexandroupolis, Thrace, Greece.
Elpis
E
Mantadakis
Eleni
E
Plessa
Evridiki K
EK
Vouloumanou
Drosos E
DE
Karageorgopoulos
Athanasios
A
Chatzimichael
Mathew E
ME
Falagas
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