title: Prognostic value of pro-adrenomedullin, procalcitonin and C-reactive protein in predicting outcome of febrile urinary tract infection.
abstract: Bacterial infections such as febrile urinary tract infection (fUTI) may run a complicated course that is difficult to foretell on clinical evaluation only. Because the conventional biomarkers erythrocyte sedimentation rate (ESR), leucocyte count, C-reactive protein (CRP) and procalcitonin (PCT) have a limited role in the prediction of a complicated course of disease, a new biomarker-plasma midregional pro-adrenomedullin (MR-proADM)-was evaluated in patients with f UTI. We conducted a prospective multicentre cohort study including consecutive patients with f UTI at 35 primary-care centres and eight emergency departments. Clinical and microbiological data were collected and plasma biomarker levels were measured at presentation to the physician. Survival was assessed after 30 days. Of 494 fUTI patients, median age was 67 (interquartile range 49-78) years, 40% were male; two-thirds of them had significant co-existing medical conditions. Median MR-proADM level was 1.42 (interquartile range 0.67-1.57) nM; significantly elevated MR-proADM levels were measured in patients with bacteraemia, those admitted to the intensive care unit, and in 30-day and 90-day non-survivors, compared with patients without these characteristics. The diagnostic accuracy for predicting 30-day mortality in fUTI, reflected by the area-under-the-curve of receiver operating characteristics were: MR-proADM 0.83 (95% CI 0.71-0.94), PCT 0.71 (95% CI 0.56-0.85); whereas CRP, ESR and leucocyte count lacked diagnostic value in this respect. This study shows that MR-proADM assessed on first contact predicts a complicated course of disease and 30-day mortality in patients with fUTI and in this respect has a higher discriminating accuracy than the currently available biomarkers ESR, CRP, PCT and leucocyte count.
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: W E
authors.initials: WE
authors.lastname: van der Starre
authors.forename: S M
authors.initials: SM
authors.lastname: Zunder
authors.forename: A M
authors.initials: AM
authors.lastname: Vollaard
authors.forename: C
authors.initials: C
authors.lastname: van Nieuwkoop
authors.forename: J E
authors.initials: JE
authors.lastname: Stalenhoef
authors.forename: N M
authors.initials: NM
authors.lastname: Delfos
authors.forename: J W
authors.initials: JW
authors.lastname: Van't Wout
authors.forename: I C
authors.initials: IC
authors.lastname: Spelt
authors.forename: J W
authors.initials: JW
authors.lastname: Blom
authors.forename: E M S
authors.initials: EM
authors.lastname: Leyten
authors.forename: T
authors.initials: T
authors.lastname: Koster
authors.forename: H C
authors.initials: HC
authors.lastname: Ablij
authors.forename: J T
authors.initials: JT
authors.lastname: van Dissel
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D005334:Fever / Q000097:blood / Q000150:complications* / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012307:Risk Factors; D016019:Survival Analysis; D014552:Urinary Tract Infections / Q000097:blood / Q000382:microbiology / Q000401:mortality*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D053607:Adrenomedullin; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: C-reactive protein; erythrocyte sedimentation rate; leucocyte count; pro-adrenomedullin; procalcitonin; pyelonephritis; urinary tract infection