Assuntos
Necrose/diagnóstico , Dermatopatias/diagnóstico , Picada de Aranha/diagnóstico , Trombocitopenia/diagnóstico , Animais , Antibacterianos/uso terapêutico , Aranha Marrom Reclusa , Pré-Escolar , Exantema/diagnóstico , Exantema/terapia , Feminino , Humanos , Necrose/terapia , Prednisona/uso terapêutico , Dermatopatias/terapia , Picada de Aranha/terapia , Trombocitopenia/terapiaRESUMO
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/diagnósticoRESUMO
OBJECTIVE: To validate high serum procalcitonin (PCT) as a predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI). STUDY DESIGN: This secondary analysis of prospective hospital-based cohort studies included children ages 1 month to 4 years with a first febrile UTI. RESULTS: Of the 398 patients included in 8 centers in 7 European countries, 25% had VUR. The median PCT concentration was significantly higher in children with VUR than in those without: 1.6 versus 0.7 ng/mL (P = 10(-4)). High PCT (> or =0.5 ng/mL) was associated with VUR (OR: 2.3; 95% CI, 1.3 to 3.9; P = 10(-3)). After adjustment for all cofactors, the association remained significant (OR: 2.5; 95% CI, 1.4 to 4.4; P = 10(-3)). The strength of the relation increased with the grade of reflux (P = 10(-5)). The sensitivity of procalcitonin was 75% (95% CI, 66 to 83) for all-grade VUR and 100% (95% CI, 81 to 100) for grade > or =4 VUR, both with 43% specificity (95% CI, 37 to 48). CONCLUSIONS: High PCT is a strong, independent and now validated predictor of VUR that can be used to identify low-risk patients and thus avoid one third of the unnecessary cystourethrographies in children with a first febrile UTI.