Julián-Jiménez A, Gutiérrez-Martín P, Lizcano-Lizcano A, López-Guerrero M A, Barroso-Manso Á, Heredero-Gálvez E
Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, España.
Servicio de Urología, Complejo Hospitalario de Toledo, Toledo, España.
Actas Urol Esp. 2015 Oct;39(8):502-10. doi: 10.1016/j.acuro.2015.03.003. Epub 2015 May 2.
The aim of this study was to analyze and compare the capacity of procalcitonin (PCT), C-reactive protein (CRP), lactate and leukocytes to predict the presence of bacteremia in patients with urinary tract infections (UTIs).
Observational, retro-prospective analytical study of adult patients (≥15 years) diagnosed with UTI in an emergency department from August 2012 to January 2013.
The study included 328 patients diagnosed with UTI, with a mean age of 52±22 years, 74% of whom were women. Of these, 43 (13.1%) had bacteremia. For predicting bacteremia, PCT achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at .993 (95% CI .987-1; P<.001). A cutoff≥1.16ng/mL achieves a sensitivity of 100%, a specificity of 97%, a positive predictive value of 84% and a negative predictive value of 100%. Lactate achieved an ROC-AUC of .844, and CRP achieved only .534. The mean values when comparing PCT levels in patients with UTIs with and without bacteremia were 8.08±16.37 and .34±.37ng/mL, respectively (P<.001).
For patients with UTIs in the emergency department, PCT achieves considerable diagnostic performance for suspecting bacteremia, a performance greater than that of lactate, CRP and leukocytes.
本研究旨在分析和比较降钙素原（PCT）、C反应蛋白（CRP）、乳酸和白细胞预测尿路感染（UTI）患者菌血症的能力。
对2012年8月至2013年1月在急诊科诊断为UTI的成年患者（≥15岁）进行观察性、回顾性分析研究。
该研究纳入了328例诊断为UTI的患者，平均年龄为52±22岁，其中74%为女性。其中43例（13.1%）有菌血症。对于预测菌血症，PCT在受试者工作特征曲线下面积（ROC-AUC）最大，为0.993（95%CI 0.987-1；P<0.001）。截断值≥1.16ng/mL时，灵敏度为100%，特异性为97%，阳性预测值为84%，阴性预测值为100%。乳酸的ROC-AUC为0.844，CRP仅为0.534。比较有菌血症和无菌血症的UTI患者的PCT水平时，平均值分别为8.08±16.37和0.34±0.37ng/mL（P<0.001）。
对于急诊科的UTI患者，PCT在怀疑菌血症方面具有相当的诊断性能，其性能优于乳酸、CRP和白细胞。
