Centre for Statistics in Medicine, University of Oxford, Oxford, UK.INSERM U953, Paris, France; Department of Pediatrics, Saint-Vincent-de-Paul Hospital, AP-HP, Paris-Descartes University, Paris, France.
To assess the predictive value of procalcitonin, a serum inflammatory marker, in the identification of children with first urinary tract infection (UTI) who might have high-grade (≥3) vesicoureteral reflux (VUR).
We conducted a meta-analysis of individual data, including all series of children aged 1 month to 4 years with a first UTI, a procalcitonin (PCT) level measurement, cystograms, and an early dimercaptosuccinic acid scan.
Of the 152 relevant identified articles, 12 studies representing 526 patients (10% with VUR ≥3) were included. PCT level was associated with VUR ≥3 as a continuous (P = .001), and as a binary variable, with a 0.5 ng/mL preferred threshold (adjusted OR, 2.5; 95% CI, 1.1 to 5.4). The sensitivity of PCT ≥0.5 ng/mL was 83% (95% CI, 71 to 91) with 43% specificity rate (95% CI, 38 to 47). In the subgroup of children with a positive results on dimercaptosuccinic acid scan, PCT ≥0.5 ng/mL was also associated with high-grade VUR (adjusted OR, 4.8; 95% CI, 1.3 to 17.6).
We confirmed that PCT is a sensitive and validated predictor strongly associated with VUR ≥3, regardless of the presence of early renal parenchymal involvement in children with a first UTI.
Leroy S, Romanello C, Galetto-Lacour A, Bouissou F, Fernandez-Lopez A, Smolkin V, Gurgoz MK, Bressan S, Karavanaki K, Tuerlinckx D, Leblond P, Pecile P, Coulais Y, Cubells C, Halevy R, Aygun AD, Da Dalt L, Stefanidis CJ, Borght TV, Bigot S, Dubos F, Gervaix A, Chalumeau M. Are you the author?
Reference: J Pediatr. 2011 Apr 19. Epub ahead of print.