Objective: The aim of this article was to assess the usefulness of procalcitonin (PCT) as a marker for predicting dilating (grades III–V) vesicoureteral reflux (VUR) in young children with a first febrile urinary tract infection.
Methods: Children ≤2 years of age with a first febrile urinary tract infection were prospectively evaluated. Serum samples were tested for PCT at the time of admission to a tertiary hospital. All children underwent renal ultrasonography (US), 99mTc-dimercaptosuccinic acid renal scan, and voiding cystourethrography. The diagnostic characteristics of PCT test for acute pyelonephritis and dilating VUR were calculated.
Results: Of 272 children analyzed (168 boys and 104 girls; median age, 5 months), 169 (62.1%) had acute pyelonephritis. There was VUR demonstrated in 97 (35.7%), including 70 (25.7%) with dilating VUR. The median PCT value was significantly higher in children with VUR than in those without (P < 0.001). Using a PCT cutoff value of ≥1.0 ng/mL, the sensitivity and negative predictive value for predicting dilating VUR were 94.3% and 95.4%, respectively, for PCT, and 97.1% and 97.8%, respectively, for the combined PCT and US studies, whereas the positive and negative likelihood ratios were 2.03 and 0.107, respectively, for PCT, and 1.72 and 0.067, respectively, for the combined studies. By multivariate analysis, high PCT values and abnormalities on US were independent predictors of dilating VUR.
Conclusions: PCT is useful for diagnosing acute pyelonephritis and predicting dilating VUR in young children with a first febrile urinary tract infection. A voiding cystourethrography is indicated only in children with high PCT values (≥1.0 ng/mL) and/or abnormalities found on a US.
From the *School of Medicine, Chung Shan Medical University Hospital; †Department of Pediatrics, Chung Shan Medical University Hospital; ‡School of Chinese Medicine, China Medical University; §Department of Pediatrics, China Medical University Hospital; ¶Institute of Medicine, Chung Shan Medical University; and ‖Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Accepted for publication March 04, 2013.
H.-L.S. and K.-H.W. contributed equally to this work.
Supported by grants from the National Science Council, Taiwan (NSC93-2314-B-040-012), and the Chung Shan Medical University, Taiwan (CSH-2011-C-015). The authors have no other funding or conflicts of interest to disclose.
Address for correspondence: Ji-Nan Sheu, MD, PhD, Department of Pediatrics, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo North Road, Taichung 402, Taiwan. E-mail: firstname.lastname@example.org.