NEW YORK (Reuters Health) – Blood levels of procalcitonin could be used to exclude a diagnosis of urinary tract infection (UTI), but they are less useful for confirming UTI, researchers report.
Procalcitonin can improve the diagnosis of bacterial infections and reduce unnecessary antibiotic exposure in patients with sepsis and pneumonia. And in patients with UTI, procalcitonin blood concentrations can distinguish acute pyelonephritis from a lower UTI.
Dr. Alexander R. Levine from the University of St. Joseph School of Pharmacy, in Hartford, Connecticut, and colleagues evaluated the value of procalcitonin for differentiating a positive and negative lower UTI and its potential role in optimizing antibiotic stewardship in 293 patients with suspected UTI.
Overall, 70 patients (45%) had a positive urine culture, and 48 of these patients were also symptomatic and met the criteria for a positive UTI.
Procalcitonin was able to predict UTI with an accuracy of 71.7%. The best procalcitonin threshold was 0.235 ng/mL, with 69% sensitivity and 63% specificity, the researchers report in the American Journal of Emergency Medicine, online March 3.
The commonly used threshold of 0.25 ng/mL for procalcitonin yielded a positive predictive value of only 26% and a negative predictive value of 91%, corresponding to a positive likelihood ratio of 1.81 and a negative likelihood ratio of 0.524.
“Procalcitonin >0.25 ng/mL was a poor predictor of UTI and should not be used to guide initiation of antibiotics,” the researchers conclude. “An initial procalcitonin value <0.25 ng/mL was highly predictive of the absence of UTI and may provide a role in facilitating non-initiation or earlier discontinuation of antibiotics.”
Dr. Levine did not respond to a request for comments.
SOURCE: https://bit.ly/2uZu088
Am J Emerg Med 2018.
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