Accuracy of Automated Flow Cytometry-Based Leukocyte Counts To Rule Out Urinary Tract Infection in Febrile Children: a Prospective Cross-Sectional Study
| Autor: | Philippe Lepage, Nathalie Tram, Khalid Ismaili, Karl Martin Wissing, Georges Mascart, Hong Phuoc Duong |
|---|---|
| Přispěvatelé: | Clinical sciences, Nephrology |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Cross-sectional study Urine Gastroenterology Leukocyte Count 0302 clinical medicine Prospective Studies febrile children Child Aged 80 and over Urinary tract infection Middle Aged Flow Cytometry medicine.anatomical_structure 030220 oncology & carcinogenesis Child Preschool Urinary Tract Infections Female Microbiology (medical) Adult medicine.medical_specialty Adolescent Bacteriuria Fever Urinary system Urinalysis Sensitivity and Specificity 03 medical and health sciences Young Adult 030225 pediatrics White blood cell Internal medicine medicine Humans study Nitrites Aged Receiver operating characteristic business.industry Infant Bacteriology automated flow cytometry-based leukocyte counts Dipstick Confidence interval Surgery Leukocyte esterase Cross-Sectional Studies Erythrocyte Count business Carboxylic Ester Hydrolases |
| Popis: | Automated flow cytometry of urine remains an incompletely validated method to rule out urinary tract infection (UTI) in children. This cross-sectional analytical study was performed to compare the predictive values of flow cytometry and a dipstick test as initial diagnostic tests for UTI in febrile children and prospectively included 1,106 children (1,247 episodes). Urine culture was used as the gold standard test for diagnosing UTI. The performance of screening tests to diagnose UTI were established using receiver operating characteristic (ROC) analysis. Among these 1,247 febrile episodes, 221 UTIs were diagnosed (17.7% [95% confidence interval {CI}, 15.6 to 19.8%]). The area under the ROC curve for flow cytometry white blood cell (WBC) counts (0.99 [95% CI, 0.98 to 0.99]) was significantly superior to that for red blood cell (0.74 [95% CI, 0.70 to 0.78]) and bacterial counts (0.89 [95% CI, 0.87 to 0.92]) ( P < 0.001). Urinary WBC counts also had a significantly higher area under the ROC curve than that of the leukocyte esterase (LE) dipstick (0.92 [95% CI, 0.90 to 0.94]), nitrite dipstick (0.83 [95% CI, 0.80 to 0.87]), or the combination of positive LE and/or nitrite dipstick (0.91 [95% CI, 0.89 to 0.93]) test ( P < 0.001). The presence of ≥35 WBC/μl of urine was the best cutoff point, yielding both a high sensitivity (99.5% [95% CI, 99 to 100%]) and an acceptable specificity (80.6% [95% CI, 78 to 83%]). Using this cutoff point would have reduced the number of samples sent to the laboratory for culture by 67%. In conclusion, the determination of urinary WBC counts by flow cytometry provides optimal performance as an initial diagnostic test for UTI in febrile children. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|