Can C-reactive protein, procalcitonin and mid-regional pro-atrial natriuretic peptide measurements guide choice of in-patient or out-patient care in acute pyelonephritis? Biomarkers In Sepsis (BIS) multicentre study
| Autor: | Y-E, Claessens, J, Schmidt, E, Batard, S, Grabar, D, Jegou, P, Hausfater, G, Kierzek, S, Guérin, J-L, Pourriat, J-F, Dhainaut, C, Ginsburg, L, Lavagna-Perez |
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| Jazyk: | angličtina |
| Předmět: |
Adult
Calcitonin Male Microbiology (medical) Emergency Medical Services medicine.medical_specialty medicine.drug_class Calcitonin Gene-Related Peptide Procalcitonin Sepsis Atrial natriuretic peptide Internal medicine Natriuretic peptide medicine Humans Prospective Studies Protein Precursors Prospective cohort study Intensive care medicine Aged Pyelonephritis biology business.industry C-reactive protein General Medicine Middle Aged medicine.disease Hospitalization C-Reactive Protein Infectious Diseases biology.protein Biomarker (medicine) Female France business Atrial Natriuretic Factor Biomarkers hormones hormone substitutes and hormone antagonists Kidney disease |
| Zdroj: | Clinical Microbiology and Infection. (6):753-760 |
| ISSN: | 1198-743X |
| DOI: | 10.1111/j.1469-0691.2009.02955.x |
| Popis: | Whereas C-reactive protein (CRP), procalcitonin (PCT) and mid-regional pro-atrial natriuretic peptide (ANP) may be of use at the bedside in the management of adult patients with infectious disorders, their usefulness has not been established in the setting of acute pyelonephritis. To assess the effectiveness of CRP, PCT and ANP measurements in guiding emergency physicians' decisions whether to admit to hospital patients with acute pyelonephritis, we conducted a multicentre, prospective, observational study in 12 emergency departments in France; 582 consecutive patients were included. The reference standard for admission was defined by experts' advice combined with necessity of admission or death during the 28-day follow-up. Baseline CRP, PCT and ANP were measured and their accuracy in identifying the necessity of admission was analysed using area under curves (AUC) of receiver–operating characteristic (ROC) plots. According to the reference standard, 126 (22%) patients required admission. ANP (AUC 0.75, 95% CI 0.69–0.80) and PCT (AUC 0.75, 95% CI 0.71–0.80) more accurately predicted this than did CRP (AUC 0.69, 95% CI 0.64–0.74). The -positive and negative likelihood ratios for each biomarker remained clinically irrelevant whatever the threshold. Our results did not support the use of these markers to help physicians in deciding about admission of patients experiencing acute pyelonephritis in daily practice. |
| Databáze: | OpenAIRE |
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