Skip to main content
SpringerLink
Log in

Diagnostic value of serum procalcitonin for acute pyelonephritis in infants and children with urinary tract infections: an updated meta-analysis

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

The aims were to assess (1) the diagnostic value of serum procalcitonin (PCT) for acute pyelonephritis (APN) in infants and children with urinary tract infections (UTIs) and (2) to compare the performance of two commonly used cutoff values.

Methods

A meta-analysis of serum PCT in the diagnosis of APN among pediatrics with lower UTIs was conducted. The process of search strategy, publications selection and data analysis was in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines.

Results

Eighteen high-quality studies with a total of 831 APN patients and 651 individuals with lower UTIs were analyzed. The overall performance of serum PCT ≥ 0.5 ng/mL was as follows: pooled sensitivity of 0.86 (95 % CI 0.73–0.93), pooled specificity of 0.76 (95 % CI 0.66–0.83), DOR of 18.90 (95 % CI 6.78–52.71) and AUROC of 0.86 (95 % CI 0.83–0.89), with significant heterogeneity. However, use of 1.0 ng/mL as a cutoff value produced an improved specificity of 0.91 (95 % CI 0.86–0.94), a DOR of 55.06 (95 % CI 22.57–115.48) and an AUROC of 0.94 (95 % CI 0.92–0.96), without obvious heterogeneity.

Conclusion

In pediatrics with UTIs, the cutoff value of serum PCT, 1.0 ng/mL, has a preferable diagnostic performance compared with 0.5 ng/mL for APN. Additional prospective studies that propose an appropriate cutoff value and validate the performance of PCT for young with APN are needed in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Marild S, Jodal U (1998) Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatr 87:549–552

    Article  CAS  PubMed  Google Scholar 

  2. Montini G, Tullus K, Hewitt I (2011) Febrile urinary tract infections in children. N Engl J Med 365:239–250

    Article  CAS  PubMed  Google Scholar 

  3. Ghasemi K, Montazeri S, Pashazadeh AM et al (2013) Correlation of DMSA scan with radiological and laboratory examinations in childhood acute pyelonephritis: a time-series study. Int Urol Nephrol 45:925–932

    Article  PubMed  Google Scholar 

  4. Finnell SM, Carroll AE, Downs SM et al (2011) Technical report-Diagnosis and management of an initial UTI in febrile infants and young children. Pediatrics 128:e749–e770

    Article  PubMed  Google Scholar 

  5. Nahar A, Akom M, Hanes D et al (2004) Pyelonephritis and acute renal failure. Am J Med Sci 328:121–123

    Article  PubMed  Google Scholar 

  6. Mohkam M, Maham S, Rahmani A et al (2010) Technetium Tc 99 m dimercaptosuccinic acid renal scintigraphy in children with acute pyelonephritis: correlation with other imaging tests. Iran J Kidney Dis 4:297–301

    PubMed  Google Scholar 

  7. Sheu JN, Chen MC, Lue KH et al (2006) Serum and urine levels of interleukin-6 and interleukin-8 in children with acute pyelonephritis. Cytokine 36:276–282

    Article  CAS  PubMed  Google Scholar 

  8. Sheu JN, Chen SM, Meng MH et al (2009) The role of serum and urine interleukin-8 on acute pyelonephritis and subsequent renal scarring in children. Pediatr Infect Dis J 28:885–890

    Article  PubMed  Google Scholar 

  9. Parenti GC, Passari A (2001) Acute pyelonephritis.Role of diagnostic imaging. Radiol Med 101:251–254

    CAS  PubMed  Google Scholar 

  10. Lavocat MP, Granjon D, Allard D et al (1997) Imaging of pyelonephritis. Pediatr Radiol 27:159–165

    Article  CAS  PubMed  Google Scholar 

  11. Assicot M, Gendrel D, Carsin H et al (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341:515–518

    Article  CAS  PubMed  Google Scholar 

  12. Kotoula A, Gardikis S, Tsalkidis A et al (2009) Comparative efficacies of procalcitonin and conventional inflammatory markers for prediction of renal parenchymal inflammation in pediatric first urinary tract infection. Urology 73:782–786

    Article  PubMed  Google Scholar 

  13. Prat C, Dominguez J, Rodrigo C et al (2003) Elevated serum procalcitonin values correlate with renal scarring in children with urinary tract infection. Pediatr Infect Dis J 22:438–442

    PubMed  Google Scholar 

  14. Belhadj JH, Coulais Y, Tafani M et al (2008) Procalcitonin implication in renal cell apoptosis induced by acute pyelonephritis in children. Infect Drug Resist 1:17–20

    Article  Google Scholar 

  15. Smolkin V, Koren A, Raz R et al (2002) Procalcitonin as a marker of acute pyelonephritis in infants and children. Pediatr Nephrol 17:409–412

    Article  PubMed  Google Scholar 

  16. Gurgoze MK, Akarsu S, Yilmaz E et al (2005) Proinflammatory cytokines and procalcitonin in children with acute pyelonephritis. Pediatr Nephrol 20:1445–1448

    Article  PubMed  Google Scholar 

  17. Nikfar R, Khotaee G, Ataee N et al (2010) Usefulness of procalcitonin rapid test for the diagnosis of acute pyelonephritis in children in the emergency department. Pediatr Int 52:196–198

    Article  CAS  PubMed  Google Scholar 

  18. Sheu JN, Chang HM, Chen SM et al (2011) The role of procalcitonin for acute pyelonephritis and subsequent renal scarring in infants and young children. J Urol 186:2002–2008

    Article  CAS  PubMed  Google Scholar 

  19. Chen SM, Chang HM, Hung TW et al (2013) Diagnostic performance of procalcitonin for hospitalised children with acute pyelonephritis presenting to the paediatric emergency department. Emerg Med J 30:406–410

    Article  PubMed  Google Scholar 

  20. Zhang L, Yu Q, Guo KP et al (2013) Role of procalcitonin in the diagnosis of acute pyelonephritis in children. Chin J Contemp Pediatri 15:85–87

    CAS  Google Scholar 

  21. Mahyar A, Ayazi P, Ahmadi R et al (2014) Are serum procalcitonin and interleukin-1 beta suitable markers for diagnosis of acute pyelonephritis in children? Prague Med Rep 115:16–23

    Article  CAS  PubMed  Google Scholar 

  22. Mantadakis E, Plessa E, Vouloumanou EK et al (2009) Serum procalcitonin for prediction of renal parenchymal involvement in children with urinary tract infections: a meta-analysis of prospective clinical studies. J Pediatr 155:875–881

    Article  CAS  PubMed  Google Scholar 

  23. Leroy SL, Fernandez LA, Nikfar R et al (2013) Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI. Pediatrics 131:870–879

    Article  PubMed  Google Scholar 

  24. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012

    Article  PubMed  Google Scholar 

  25. Whiting P, Rutjes AW, Reitsma JB et al (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25

    Article  PubMed Central  PubMed  Google Scholar 

  26. Reitsma JB, Glas AS, Rutjes AW et al (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58:982–990

    Article  PubMed  Google Scholar 

  27. Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 58:882–893

    Article  PubMed  Google Scholar 

  28. Benador N, Siegrist CA, Gendrel D et al (1998) Procalcitonin is a marker of severity of renal lesions in pyelonephritis. Pediatrics 102:1422–1425

    Article  CAS  PubMed  Google Scholar 

  29. Gervaix A, Galetto LA, Gueron T et al (2001) Usefulness of procalcitonin and C-reactive protein rapid tests for the management of children with urinary tract infection. Pediatr Infect Dis J 20:507–511

    Article  CAS  PubMed  Google Scholar 

  30. Pecile P, Miorin E, Romanello C et al (2004) Procalcitonin: a marker of severity of acute pyelonephritis among children. Pediatrics 114:e249–e254

    Article  PubMed  Google Scholar 

  31. Tuerlinckx D, Vander BT, Glupczynski Y et al (2005) Is procalcitonin a good marker of renal lesion in febrile urinary tract infection? Eur J Pediatr 164:651–652

    Article  PubMed  Google Scholar 

  32. Bigot S, Leblond P, Foucher C et al (2005) Usefulness of procalcitonin for the diagnosis of acute pyelonephritis in children. Arch Pediatr 12:1075–1080

    Article  CAS  PubMed  Google Scholar 

  33. Guven AG, Kazdal HZ, Koyun M et al (2006) Accurate diagnosis of acute pyelonephritis: how helpful is procalcitonin? Nucl Med Commun 27:715–721

    Article  PubMed  Google Scholar 

  34. Karavanaki K, Haliotis AF, Sourani M et al (2007) DMSA Scintigraphy in Febrile Urinary Tract Infections Could Be Omitted in Children With Low Procalcitonin Levels. Infect Dis Clin Pract 15:377–381

    Article  Google Scholar 

  35. Kotoula A, Gardikis S, Tsalkidis A et al (2009) Procalcitonin for the early prediction of renal parenchymal involvement in children with UTI: preliminary results. Int Urol Nephrol 41:393–399

    Article  PubMed  Google Scholar 

  36. Sun HL, Wu KH, Chen SM et al (2013) Role of procalcitonin in predicting dilating vesicoureteral reflux in young children hospitalized with a first febrile urinary tract infection. Pediatr Infect Dis J 32:e348–e354

    Article  PubMed  Google Scholar 

  37. Bouguila J, Khalef I, Charfeddine B et al (2013) Comparative study of C-reactive protein and procalcitonin in the severity diagnosis of pyelonephritis in children. Pathol Biol (Paris) 61:93–98

    Article  CAS  Google Scholar 

  38. Xu RY, Liu HW, Liu JL et al (2014) Procalcitonin and C-reactive protein in urinary tract infection diagnosis. BMC Urol 14:45–49

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China

    Huhai Zhang, Jurong Yang, Lirong Lin, Bengang Huo, Huanzi Dai & Yani He

Authors
  1. Huhai Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jurong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lirong Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bengang Huo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Huanzi Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yani He
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yani He.

Ethics declarations

Conflict of interest

No conflict of interest was declared.

Ethical statement

The manuscript does not contain original clinical studies.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Fig. S1

Methodological quality graph. Reviewer judgment of methodological quality of each individual study included in the analysis, according to the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review (QUADAS) tool (TIFF 323 kb)

Fig. S2

Deeks’ plots for included studies. (A) Derived from studies using cutoff value of 0.5 ng/mL. (B) Derived from studies using cutoff value of 1.0 ng/mL. Linear regression of log odds ratios on inverse root of effective sample sizes as a test for funnel plot asymmetry in diagnostic meta-analysis. A nonzero slope coefficient is suggestive of significant small study bias (p < 0.10) (TIFF 904 kb)

Supplementary material 3 (DOC 76 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, H., Yang, J., Lin, L. et al. Diagnostic value of serum procalcitonin for acute pyelonephritis in infants and children with urinary tract infections: an updated meta-analysis. World J Urol 34, 431–441 (2016). https://doi.org/10.1007/s00345-015-1630-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-015-1630-4

Keywords

Search

Navigation