Published online May 2, 2005
PEDIATRICS Vol. 115 No. 6 June 2005, pp. e706-e709 (doi:10.1542/peds.2004-1631)

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Leroy, S. Articles by Chalumeau, M. Search for Related Content PubMed PubMed Citation Articles by Leroy, S. Articles by Chalumeau, M. Related Collections Genitourinary Tract Social Bookmarking                         What's this?

ELECTRONIC ARTICLE

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Sandrine Leroy, MD^*, Catherine Adamsbaum, MD, Elisabeth Marc, MD, Florence Moulin, MD, Josette Raymond, MD, PhD^||, Dominique Gendrel, MD^*, Gérard Bréart, MD^¶ and Martin Chalumeau, MD, PhD^*,¶

^* Clinical Epidemiology Unit, Department of Pediatrics, and Departments of
Radiology
Emergency Medicine, and
^|| Department of Bacteriology, Saint-Vincent-de-Paul Hospital, AP-HP, Université Paris V, Paris, France
^¶ Institut National de la Santé et de la Recherche Médicale U149, Paris, France

Objective. A first febrile urinary tract infection leads to the diagnosis of vesicoureteral reflux in 20% to 40% of children. Systematic voiding cystourethrography 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 relationship 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 vesicoureteral reflux. The median procalcitonin concentration 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 sensitivities 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 independent predictor of vesicoureteral reflux and could be used to identify low-risk patients to avoid unnecessary voiding cystourethrography.

---

Key Words: children • prediction • procalcitonin • urinary tract infection • vesicoureteral reflux

Abbreviations: UTI, urinary tract infection • VUR, vesicoureteral reflux • PCT, procalcitonin • OR, odds ratio • CI, confidence interval

---

Accepted Dec 21, 2004.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S Leroy, E Marc, C Adamsbaum, D Gendrel, G Breart, and M Chalumeau Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule Arch. Dis. Child., March 1, 2006; 91(3): 241 - 244. [Abstract] [Full Text] [PDF]