The potential impact of biomarker-guided triage decisions for patients with urinary tract infections
- First Online:
- 284 Downloads
Current guidelines provide limited evidence as to which patients with urinary tract infection (UTI) require hospitalisation. We evaluated the currently used triage routine and tested whether a set of criteria including biomarkers like proadrenomedullin (proADM) and urea have the potential to improve triage decisions.
Consecutive adults with UTI presenting to our emergency department (ED) were recruited and followed for 30 days. We defined three virtual triage algorithms, which included either guideline-based clinical criteria, optimised admission proADM or urea levels in addition to a set of clinical criteria. We compared actual treatment sites and observed adverse events based on the physician judgment with the proportion of patients assigned to treatment sites according to the three virtual algorithms. Adverse outcome was defined as transfer to the intensive care unit (ICU), death, recurrence of UTI or rehospitalisation for any reason.
We recruited 127 patients (age 61.8 ± 20.8 years; 73.2 % females) and analysed the data of 123 patients with a final diagnosis of UTI. Of these 123 patients, 27 (22.0 %) were treated as outpatients. Virtual triage based only on clinical signs would have treated only 22 (17.9 %) patients as outpatients, with higher proportions of outpatients equally in both biomarker groups (29.3 %; p = 0.02). There were no significant differences in adverse events between outpatients according to the clinical (4.5 %), proADM (2.8 %) or urea groups (2.8 %). The mean length of stay was 6.6 days, including 2.2 days after reaching medical stability.
Adding biomarkers to clinical criteria has the potential to improve risk-based triage without impairing safety. Current rates of admission and length of stay could be shortened in patients with UTI.
KeywordsUrinary tract infection Triage Biomarkers
- 1.Nicolle LE. Epidemiology of urinary tract infections. Infect Med. 2001;18:153–62.Google Scholar
- 14.Hooton TM. Clinical manifestations; diagnosis; and treatment of acute pyelonephritis. In: Calderwood SB, Baron EL, editors. UpToDate. Retrieved from http://www.uptodate.com/home/index.html.
- 15.Grabe M, Bjerklund-Johansen TE, Botto H, Çek M, Naber KG, Tenke P, Wagenlehner F. Guidelines on urological infections. European Association of Urology (EAU) guidelines. Edition presented at the 25th Anniversary EAU Congress, Barcelona, Spain, April 2010.Google Scholar
- 30.Claessens YE, Schmidt J, Batard E, et al. Can C-reactive protein, procalcitonin and mid-regional pro-atrial natriuretic peptide measurements guide choice of in-patient or out-patient care in acute pyelonephritis? Biomarkers In Sepsis (BIS) multicentre study. Clin Microbiol Infect. 2010;16:753–60. doi:10.1111/j.1469-0691.2009.02955.x.Google Scholar
- 33.Businger AP, Kaderli R, Burghardt LR, Osinga R, Liesch M, Furrer M. Demographic changes and their implications in a nonacademic emergency department in Switzerland: an 11-year trend analysis (2000–2010) of 104,510 patients. ISRN Emerg Med. 2012:Article ID 865861;2012. doi:10.5402/2012/865861.