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J Pediatr ; 159(4): 644-51.e4, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21511275

RESUMO

OBJECTIVE: To assess the predictive value of procalcitonin, a serum inflammatory marker, in the identification of children with first urinary tract infection (UTI) who might have high-grade (≥3) vesicoureteral reflux (VUR). STUDY DESIGN: We conducted a meta-analysis of individual data, including all series of children aged 1 month to 4 years with a first UTI, a procalcitonin (PCT) level measurement, cystograms, and an early dimercaptosuccinic acid scan. RESULTS: Of the 152 relevant identified articles, 12 studies representing 526 patients (10% with VUR ≥3) were included. PCT level was associated with VUR ≥3 as a continuous (P = .001), and as a binary variable, with a 0.5 ng/mL preferred threshold (adjusted OR, 2.5; 95% CI, 1.1 to 5.4). The sensitivity of PCT ≥0.5 ng/mL was 83% (95% CI, 71 to 91) with 43% specificity rate (95% CI, 38 to 47). In the subgroup of children with a positive results on dimercaptosuccinic acid scan, PCT ≥0.5 ng/mL was also associated with high-grade VUR (adjusted OR, 4.8; 95% CI, 1.3 to 17.6). CONCLUSIONS: We confirmed that PCT is a sensitive and validated predictor strongly associated with VUR ≥3, regardless of the presence of early renal parenchymal involvement in children with a first UTI.


Assuntos
Calcitonina/sangue , Precursores de Proteínas/sangue , Refluxo Vesicoureteral/diagnóstico , Peptídeo Relacionado com Gene de Calcitonina , Pré-Escolar , Dilatação Patológica , Humanos , Lactente , Recém-Nascido , Rim/diagnóstico por imagem , Valor Preditivo dos Testes , Radiografia , Cintilografia , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Ácido Dimercaptossuccínico Tecnécio Tc 99m , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Sistema Urinário/patologia , Infecções Urinárias/diagnóstico
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