Kosin Med J.  2018 Dec;33(3):337-346. 10.7180/kmj.2018.33.3.337.

A study of the effectiveness of using the serum procalcitonin level as a predictive test for bacteremia in acute pyelonephritis

• Lee GH
• Lee YJ
• Kim YW
• Park S
• Park J
• Park KM
• Jin K
• Park BS

• KMID: 2442544
• DOI: http://doi.org/10.7180/kmj.2018.33.3.337

Abstract

OBJECTIVES
Serum procalcitonin (PCT) is a specific biomarker that rises after bacterial infection, and levels of PCT are known to correlate with the severity and mortality of patients with pneumonia and sepsis. However, the usefulness of PCT levels in acute pyelonephritis is unknown. This study aimed to evaluate the effectiveness of using the PCT level as a predictive test for bacteremia in acute pyelonephritis.
METHODS
Between January 2012 and June 2013, 140 patients diagnosed with acute pyelonephritis were admitted to Haeundae Paik Hospital. Serum PCT, C-reactive protein (CRP), and white blood cell (WBC) levels at pre- and post- treatment were measured. Blood and urine cultures were obtained from all patients. The levels of PCT, CRP, and WBCs were each compared between the blood culture-positive and blood culture-negative groups to assess their effectiveness in predicting bacteremia.
RESULTS
Pre-treatment PCT level was 0.77 ng/mL (95% CI: 0.42-1.60 ng/mL) in the blood culture-negative group and 4.89 ng/mL (95% CI: 2.88-9.04 ng/mL) in the blood culture-positive group, and the increase between the two groups was statistically significant. The area under the receiver operating characteristic curve of PCT level for prediction of bacteremia was 0.728. A cut-off value of 1.23 ng/mL indicated a sensitivity of 79.0 % and specificity of 60.0 % for PCT level.
CONCLUSIONS
Serum PCT level is a useful predictive test for bacteremia in acute pyelonephritis. Through the early detection of bacteremia, serum PCT level can help estimate the prognosis and predict complications such as sepsis.

Keyword

Bacteremia; Procalcitonin; Pyelonephritis

MeSH Terms

Bacteremia*
Bacterial Infections
C-Reactive Protein
Humans
Leukocytes
Mortality
Pneumonia
Prognosis
Pyelonephritis*
ROC Curve
Sensitivity and Specificity
Sepsis
C-Reactive Protein

Figure

• 

  Fig. 1 ROC curves of procalcitonin, C-reactive protein for prediction of bacteremia Procal, procalcitonin: CRP, C-reactive protein: ROC, receiver operating characteristic

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