title: Procalcitonin is a predictor for high-grade vesicoureteral reflux in children: meta-analysis of individual patient data.
abstract: OBJECTIVE
  To assess the predictive value of procalcitonin, a serum inflammatory marker, in the identification of children with first urinary tract infection (UTI) who might have high-grade (≥3) vesicoureteral reflux (VUR).
  
  
  METHODS
  We conducted a meta-analysis of individual data, including all series of children aged 1 month to 4 years with a first UTI, a procalcitonin (PCT) level measurement, cystograms, and an early dimercaptosuccinic acid scan.
  
  
  RESULTS
  Of the 152 relevant identified articles, 12 studies representing 526 patients (10% with VUR ≥3) were included. PCT level was associated with VUR ≥3 as a continuous (P = .001), and as a binary variable, with a 0.5 ng/mL preferred threshold (adjusted OR, 2.5; 95% CI, 1.1 to 5.4). The sensitivity of PCT ≥0.5 ng/mL was 83% (95% CI, 71 to 91) with 43% specificity rate (95% CI, 38 to 47). In the subgroup of children with a positive results on dimercaptosuccinic acid scan, PCT ≥0.5 ng/mL was also associated with high-grade VUR (adjusted OR, 4.8; 95% CI, 1.3 to 17.6).
  
  
  CONCLUSIONS
  We confirmed that PCT is a sensitive and validated predictor strongly associated with VUR ≥3, regardless of the presence of early renal parenchymal involvement in children with a first UTI.
authors.affiliation: Centre for Statistics in Medicine, University of Oxford, Oxford, UK. Sandrine.Leroy@pasteur.fr
authors.forename: Sandrine
authors.initials: S
authors.lastname: Leroy
authors.forename: Carla
authors.initials: C
authors.lastname: Romanello
authors.forename: Annick
authors.initials: A
authors.lastname: Galetto-Lacour
authors.forename: François
authors.initials: F
authors.lastname: Bouissou
authors.forename: Anna
authors.initials: A
authors.lastname: Fernandez-Lopez
authors.forename: Vladislav
authors.initials: V
authors.lastname: Smolkin
authors.forename: Metin K
authors.initials: MK
authors.lastname: Gurgoze
authors.forename: Metin K
authors.initials: MK
authors.lastname: Gurgoz
authors.forename: Silvia
authors.initials: S
authors.lastname: Bressan
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Karavanaki
authors.forename: David
authors.initials: D
authors.lastname: Tuerlinckx
authors.forename: Pierre
authors.initials: P
authors.lastname: Leblond
authors.forename: Paolo
authors.initials: P
authors.lastname: Pecile
authors.forename: Yvon
authors.initials: Y
authors.lastname: Coulais
authors.forename: Carlos
authors.initials: C
authors.lastname: Cubells
authors.forename: Raphael
authors.initials: R
authors.lastname: Halevy
authors.forename: A Denizmen
authors.initials: AD
authors.lastname: Aygun
authors.forename: Liliana
authors.initials: L
authors.lastname: Da Dalt
authors.forename: Constantinos J
authors.initials: CJ
authors.lastname: Stefanidis
authors.forename: Thierry
authors.initials: T
authors.lastname: Vander Borght
authors.forename: Sandra
authors.initials: S
authors.lastname: Bigot
authors.forename: François
authors.initials: F
authors.lastname: Dubos
authors.forename: Alain
authors.initials: A
authors.lastname: Gervaix
authors.forename: Martin
authors.initials: M
authors.lastname: Chalumeau
mesh_terms: D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002675:Child, Preschool; D004108:Dilatation, Pathologic; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D011859:Radiography; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014551:Urinary Tract / Q000473:pathology; D014552:Urinary Tract Infections / Q000175:diagnosis; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis*
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide