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Vol. 39. Issue 8.
Pages 502-510 (October 2015)
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Vol. 39. Issue 8.
Pages 502-510 (October 2015)
Original article
DOI: 10.1016/j.acuroe.2015.07.011
Usefulness of procalcitonin and C-reactive protein for predicting bacteremia in urinary tract infections in the emergency department
Utilidad de la procalcitonina y proteína C reactiva parapredecir bacteriemia en las infecciones del tractourinario en el servicio de urgencias
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A. Julián-Jiméneza,
Corresponding author
agustinj@sescam.jccm.es

Corresponding author.
, P. Gutiérrez-Martínb, A. Lizcano-Lizcanoa, M.A. López-Guerreroc, Á. Barroso-Mansob, E. Heredero-Gálvezd
a Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, Spain
b Servicio de Urología, Complejo Hospitalario de Toledo, Toledo, Spain
c Servicio de Medicina Interna, Complejo Hospitalario de Toledo, Toledo, Spain
d Servicio de Microbiología, Complejo Hospitalario de Toledo, Toledo, Spain
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Tables (5)
Table 1. Sociodemographic and clinical characteristics of patients seen in the emergency department with urinary tract infection.
Table 2. Microbiological diagnoses.
Table 3. Average values of biomarkers, leukocytes and blood lactate in the UTIs with/without associated bacteremia.
Table 4. Relationship between the concentrations of biomarkers and clinical situations of severity and mortality.
Table 5. Cut-off points and diagnostic performance in predicting bacteremia in UTI.
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Abstract
Introduction

The aim of this study was to analyze and compare the capacity of procalcitonin (PCT), C-reactive protein (CRP), lactate and leukocytes to predict the presence of bacteremia in patients with urinary tract infections (UTIs).

Methods

Observational, retro-prospective analytical study of adult patients (≥15 years) diagnosed with UTI in an emergency department from August 2012 to January 2013.

Results

The study included 328 patients diagnosed with UTI, with a mean age of 52±22 years, 74% of whom were women. Of these, 43 (13.1%) had bacteremia. For predicting bacteremia, PCT achieved the largest area under the receiver operating characteristic curve (ROC–AUC) at 0.993 (95% CI: 0.987–1; p<0.001). A cutoff ≥1.16ng/ml achieves a sensitivity of 100%, a specificity of 97%, a positive predictive value of 84% and a negative predictive value of 100%. Lactate achieved an ROC–AUC of 0.844, and CRP achieved only 0.534.

The mean values when comparing PCT levels in patients with UTIs with and without bacteremia were 8.08±16.37 and 0.34±0.37ng/ml, respectively (p<0.001).

Conclusions

For patients with UTIs in the emergency department, PCT achieves considerable diagnostic performance for suspecting bacteremia, a performance greater than that of lactate, CRP and leukocytes.

Keywords:
Procalcitonin
C-reactive protein
Biomarkers
Urinary tract infection
Bacteremia
Emergency department
Resumen
Introducción

El objetivo del estudio fue analizar y comparar la capacidad de la procalcitonina (PCT), proteína C reactiva (PCR), lactato y leucocitos para predecir la existencia de bacteriemia en los pacientes con infección del tracto urinario (ITU).

Métodos

Estudio observacional, retroprospectivo y analítico de pacientes adultos (≥15 años) diagnosticados de ITU en un servicio de urgencias desde agosto de 2012 hasta enero de 2013.

Resultados

Se incluyeron 328 casos diagnosticados de ITU con una edad media de 52±22 años, el 74% mujeres. De ellos 43 (13,1%) con bacteriemia. Para predecir bacteriemia la PCT obtiene la mayor área bajo la curva ROC (ABC-ROC), de 0,993 (IC 95%: 0,987-1, p<0,001) y con un punto de corte ≥1,16ng/ml se consigue una sensibilidad del 100%, especificidad del 97%, un valor predictivo positivo de 84% y un valor predictivo negativo del 100%. El lactato consigue un ABC-ROC de 0,844 y la PCR solo de 0,534.

Los valores medios al comparar la PCT en pacientes con ITU con/sin bacteriemia fueron 8,08±16,37 vs 0,34±0,37ng/ml, p<0,001.

Conclusiones

En los pacientes con ITU en el servicio de urgencias la PCT consigue un gran rendimiento diagnóstico para sospechar bacteriemia, mayor que el lactato, la PCR y los leucocitos.

Palabras clave:
Procalcitonina
Proteína C reactiva
Biomarcadores
Infección del tracto urinario
Bacteriemia
Servicio de urgencias

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