A Single Procalcitonin Level Does Not Predict Adverse Outcomes of Women with Pyelonephritis

• Published in: European urology Vol. 51; no. 5; pp. 1394 - 1401
• Main Authors: Lemiale, Virginie, Renaud, Bertrand, Moutereau, Stéphane, N'Gako, Alfred, Salloum, Mirna, Calmettes, Marie Jeanne, Hervé, Jérôme, Boraud, Cyril, Santin, Aline, Grégo, Jean-Claude, Braconnier, François, Roupie, Eric
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01.05.2007; Elsevier
• Subjects: Acute Disease; Adult; Biological and medical sciences; Biomarkers - blood; Calcitonin - blood; Calcitonin Gene-Related Peptide; Emergency medicine; Female; Hospitalization; Humans; Interstitial nephritis; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Outcome; Prediction; Procalcitonin; Protein Precursors - blood; Pyelonephritis; Pyelonephritis - blood; Pyelonephritis - classification; Pyelonephritis - complications; Pyelonephritis - diagnosis; Risk Factors; Sensitivity and Specificity; Urology; Hospitalization; Pyelonephritis; Procalcitonin; Outcome; Emergency medicine; Prediction; Human; Kidney disease; Nephrology; Urinary system disease; Prognosis; Urology; Ascending pyelonephritis; Medicine; Adult; Female; Emergency; Predictive factor; Woman
• ISSN: 0302-2838
• DOI: 10.1016/j.eururo.2006.12.018

Predicting medical outcomes for pyelonephritis in women is difficult, leading to unnecessary hospitalization. Unlike other serious infectious diseases, high procalcitonin (PCT) level has never been associated with 28-d adverse medical outcomes in women with pyelonephritis. Therefore, we sought to determine the accuracy of PCT in discriminating between pyelonephritis with adverse medical outcome (PAMO) and pyelonephritis without adverse medical outcome (PWAMO). Adult women with pyelonephritis presenting to the emergency department of a French tertiary care hospital were consecutively included. Those patients who developed adverse medical outcomes during a 28-d follow-up period were identified as having PAMO. Baseline characteristics and PCT level were compared between patients with PAMO and PWAMO. Eleven women (19.0%) had PAMO and 47 (81%) had PWAMO. The median PCT level was higher in PAMO compared with PWAMO 0.51ng/ml (IQR: 0.04–3.8) and 0.08ng/ml (IQR: 0.01–1.0), but this difference was not statistically significant (p=0.07). We failed to find a threshold value for PCT that discriminated between PAMO and PWAMO (ROC, AUC=0.67 [95%CI, 0.51–0.86]). All but one subject with PAMO had either a PCT level >0.1ng/ml or an underlying genitourinary abnormality by radiographic testing. A single PCT level was a poor predictor of 28-d adverse medical outcomes in women with pyelonephritis treated in the emergency department. Prediction based on underlying genitourinary abnormality by radiographic testing in addition to the PCT level should be investigated in future studies. A single PCT level poorly predicted adverse outcomes in adult women with pyelonephritis treated in the emergency department.