Diagnostic performance of procalcitonin for hospitalised children with acute pyelonephritis presenting to the paediatric emergency department

Shan Ming Chen, Hung Ming Chang, Tung Wei Hung, Yu Hua Chao, Jeng Dau Tsai, Ko Huang Lue, Ji Nan Sheu

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: Urinary tract infection (UTI) is a common bacterial infection in children that can result in permanent renal damage. This study prospectively assessed the diagnostic performance of procalcitonin (PCT) for predicting acute pyelonephritis (APN) among children with febrile UTI presenting to the paediatric emergency department (ED). Methods: Children aged ≤10 years with febrile UTI admitted to hospital from the paediatric ED were prospectively studied. Blood PCT, C reactive protein (CRP) and white blood cell (WBC) count were measured in the ED. Sensitivity, specificity, predictive values, multilevel likelihood ratios, receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess quantitative variables for diagnosing APN. Results: The 136 enrolled patients (56 boys and 80 girls; age range 1 month to 10 years) were divided into APN (n=87) and lower UTI (n=49) groups according to 99mTc-dimercaptosuccinic acid scan results. The cut-off value for maximum diagnostic performance of PCT was 1.3 ng/ml (sensitivity 86.2%, specificity 89.8%). By multivariate regression analysis, only PCT and CRP were retained as significant predictors of APN. Comparing ROC curves, PCT had a significantly greater area under the curve than CRP, WBC count and fever for differentiating between APN and lower UTI. Conclusions: PCT has better sensitivity and specificity than CRP and WBC count for distinguishing between APN and lower UTI. PCT is a valuable marker for predicting APN in children with febrile UTI. It may be considered in the initial investigation and therapeutic strategies for children presenting to the ED.

Original languageEnglish
Pages (from-to)406-410
Number of pages5
JournalEmergency medicine journal : EMJ
Volume30
Issue number5
DOIs
Publication statusPublished - May 2013
Externally publishedYes

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Hospitalized Child
Pyelonephritis
Calcitonin
Urinary Tract Infections
Hospital Emergency Service
Pediatrics
C-Reactive Protein
Fever
Leukocyte Count
Sensitivity and Specificity
ROC Curve
Multivariate Analysis
Technetium Tc 99m Dimercaptosuccinic Acid
Pediatric Hospitals
Bacterial Infections
Area Under Curve
Logistic Models
Regression Analysis
Kidney

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine

Cite this

Diagnostic performance of procalcitonin for hospitalised children with acute pyelonephritis presenting to the paediatric emergency department. / Chen, Shan Ming; Chang, Hung Ming; Hung, Tung Wei; Chao, Yu Hua; Tsai, Jeng Dau; Lue, Ko Huang; Sheu, Ji Nan.

In: Emergency medicine journal : EMJ, Vol. 30, No. 5, 05.2013, p. 406-410.

Research output: Contribution to journalArticle

Chen, Shan Ming ; Chang, Hung Ming ; Hung, Tung Wei ; Chao, Yu Hua ; Tsai, Jeng Dau ; Lue, Ko Huang ; Sheu, Ji Nan. / Diagnostic performance of procalcitonin for hospitalised children with acute pyelonephritis presenting to the paediatric emergency department. In: Emergency medicine journal : EMJ. 2013 ; Vol. 30, No. 5. pp. 406-410.
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abstract = "Objectives: Urinary tract infection (UTI) is a common bacterial infection in children that can result in permanent renal damage. This study prospectively assessed the diagnostic performance of procalcitonin (PCT) for predicting acute pyelonephritis (APN) among children with febrile UTI presenting to the paediatric emergency department (ED). Methods: Children aged ≤10 years with febrile UTI admitted to hospital from the paediatric ED were prospectively studied. Blood PCT, C reactive protein (CRP) and white blood cell (WBC) count were measured in the ED. Sensitivity, specificity, predictive values, multilevel likelihood ratios, receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess quantitative variables for diagnosing APN. Results: The 136 enrolled patients (56 boys and 80 girls; age range 1 month to 10 years) were divided into APN (n=87) and lower UTI (n=49) groups according to 99mTc-dimercaptosuccinic acid scan results. The cut-off value for maximum diagnostic performance of PCT was 1.3 ng/ml (sensitivity 86.2{\%}, specificity 89.8{\%}). By multivariate regression analysis, only PCT and CRP were retained as significant predictors of APN. Comparing ROC curves, PCT had a significantly greater area under the curve than CRP, WBC count and fever for differentiating between APN and lower UTI. Conclusions: PCT has better sensitivity and specificity than CRP and WBC count for distinguishing between APN and lower UTI. PCT is a valuable marker for predicting APN in children with febrile UTI. It may be considered in the initial investigation and therapeutic strategies for children presenting to the ED.",
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AU - Lue, Ko Huang

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