title: Role of procalcitonin in predicting dilating vesicoureteral reflux in young children hospitalized with a first febrile urinary tract infection.
abstract: OBJECTIVE
  The aim of this article was to assess the usefulness of procalcitonin (PCT) as a marker for predicting dilating (grades III-V) vesicoureteral reflux (VUR) in young children with a first febrile urinary tract infection.
  
  
  METHODS
  Children ≤2 years of age with a first febrile urinary tract infection were prospectively evaluated. Serum samples were tested for PCT at the time of admission to a tertiary hospital. All children underwent renal ultrasonography (US), Tc-dimercaptosuccinic acid renal scan, and voiding cystourethrography. The diagnostic characteristics of PCT test for acute pyelonephritis and dilating VUR were calculated.
  
  
  RESULTS
  Of 272 children analyzed (168 boys and 104 girls; median age, 5 months), 169 (62.1%) had acute pyelonephritis. There was VUR demonstrated in 97 (35.7%), including 70 (25.7%) with dilating VUR. The median PCT value was significantly higher in children with VUR than in those without (P < 0.001). Using a PCT cutoff value of ≥1.0 ng/mL, the sensitivity and negative predictive value for predicting dilating VUR were 94.3% and 95.4%, respectively, for PCT, and 97.1% and 97.8%, respectively, for the combined PCT and US studies, whereas the positive and negative likelihood ratios were 2.03 and 0.107, respectively, for PCT, and 1.72 and 0.067, respectively, for the combined studies. By multivariate analysis, high PCT values and abnormalities on US were independent predictors of dilating VUR.
  
  
  CONCLUSIONS
  PCT is useful for diagnosing acute pyelonephritis and predicting dilating VUR in young children with a first febrile urinary tract infection. A voiding cystourethrography is indicated only in children with high PCT values (≥1.0 ng/mL) and/or abnormalities found on a US.
authors.affiliation: From the *School of Medicine, Chung Shan Medical University Hospital; †Department of Pediatrics, Chung Shan Medical University Hospital; ‡School of Chinese Medicine, China Medical University; §Department of Pediatrics, China Medical University Hospital; ¶Institute of Medicine, Chung Shan Medical University; and ‖Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Hai-Lun
authors.initials: HL
authors.lastname: Sun
authors.forename: Kang-Hsi
authors.initials: KH
authors.lastname: Wu
authors.forename: Shan-Ming
authors.initials: SM
authors.lastname: Chen
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Chao
authors.forename: Min-Sho
authors.initials: MS
authors.lastname: Ku
authors.forename: Tong-Wei
authors.initials: TW
authors.lastname: Hung
authors.forename: Pen-Fen
authors.initials: PF
authors.lastname: Liao
authors.forename: Ko-Huang
authors.initials: KH
authors.lastname: Lue
authors.forename: Ji-Nan
authors.initials: JN
authors.lastname: Sheu
mesh_terms: D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D011704:Pyelonephritis / Q000175:diagnosis* / Q000473:pathology*; D011859:Radiography; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D044967:Serum / Q000737:chemistry; D019783:Technetium Tc 99m Dimercaptosuccinic Acid / Q000008:administration & dosage; D014463:Ultrasonography; D014481:United States; D014552:Urinary Tract Infections / Q000150:complications*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis* / Q000473:pathology*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide