Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection
| Autor: | Florence Moulin, Josette Raymond, Catherine Adamsbaum, Elisabeth Marc, Dominique Gendrel, Sandrine Leroy, Gérard Bréart, Martin Chalumeau |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Calcitonin
Male medicine.medical_specialty Multivariate analysis Fever Calcitonin Gene-Related Peptide Urology Urinary system Sensitivity and Specificity Vesicoureteral reflux Procalcitonin Cohort Studies medicine Humans Protein Precursors Retrospective Studies Vesico-Ureteral Reflux business.industry Confounding Infant Newborn Reflux Infant Odds ratio medicine.disease Confidence interval Child Preschool Urinary Tract Infections Pediatrics Perinatology and Child Health Female business Biomarkers Cohort study |
| Zdroj: | Pediatrics. 115:e706-e709 |
| ISSN: | 1098-4275 0031-4005 |
| Popis: | Objective. A first febrile urinary tract in- fection leads to the diagnosis of vesicoureteral reflux in 20% to 40% of children. Systematic voiding cystoure- thrography then is recommended. However, for 60% to 80% of the children, voiding cystourethrography is a posteriori normal. Moreover, it is irradiating, painful, and expensive. Thus, selective approaches are needed. Because procalcitonin has been shown to be associated with severe pyelonephritis and renal scars, which are correlated to vesicoureteral reflux, we analyzed its rela- tionship with vesicoureteral reflux. Methods. A retrospective hospital-based cohort study included all children who were 1 month to 4 years of age and had a first febrile urinary tract infection. Univariate and multivariate analyses were performed. Results. Among 136 patients included, 25% had vesi- coureteral reflux. The median procalcitonin concentra- tion was significantly higher in children with reflux than in those without (1.2 vs 0.6 ng/mL). High procalcitonin (>0.5 ng/mL) was associated with reflux (odds ratio (OR): 4.6; 95% confidence interval (CI): 1.6-16.2). After logistic- regression adjustment for all potential confounders, the association remained significant (OR: 4.9; 95% CI: 1.7- 14.0). The relationship was stronger for high-grade (>3) reflux (OR: 8.7; 95% CI: 1.2-382) than low-grade reflux (OR: 3.6; 95% CI: 1.1-15.3). High procalcitonin sensitivi- ties were 85% (95% CI: 70-94) and 92% (95% CI: 65-99) for all-grade and high-grade reflux, respectively, with 44% specificity (95% CI: 35-54). Conclusion. High procalcitonin is a strong and inde- pendent predictor of vesicoureteral reflux and could be used to identify low-risk patients to avoid unnecessary voiding cystourethrography. Pediatrics 2005;115:e706-e709. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2004-1631; children, prediction, procalcitonin, urinary tract infection, vesicoureteral reflux. |
| Databáze: | OpenAIRE |
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