Department of Pharmacy Practice, University of Saint Joseph School of Pharmacy, United States; Department of Pharmacy, Saint Francis Hospital and Medical Center, United States.
Department of Pharmacy, Kingsbrook Jewish Medical Center, United States.
Am J Emerg Med. 2018 Nov;36(11):1993-1997. doi: 10.1016/j.ajem.2018.03.001. Epub 2018 Mar 3.
Urinary tract infections (UTIs) are one of the most common reasons women seek treatment in the emergency department (ED). The biomarker procalcitonin (PCT) has gained popularity over the last decade to improve the diagnosis of bacterial infections and reduce unnecessary exposure to antibiotics. PCT has been extensively studied in patients with pneumonia and sepsis and may have additional role in UTI.
A retrospective study of patients who presented to the ED in which a urinalysis test and a PCT level was obtained within the first 24h of presentation. Signs and symptoms of UTI and urine cultures were reviewed to determine a positive diagnosis of UTI. The area under the receiver operating curve was used to calculate the test characteristics of PCT. Different breakpoints were analyzed to determine which PCT level corresponded to the highest sensitivity and specificity.
293 patients were included in this single center, retrospective study. The AUC of PCT to predict UTI was 0.717; 95% CI: 0.643-0.791 (p<0.001). A PCT threshold of 0.25ng/ml corresponded to the best combination of sensitivity (67%) and specificity (63%), with a positive predictive value and negative predictive value of 26% and 91%, respectively.
A PCT threshold <0.25ng/ml was a strong predictor of the absence of UTI. The high negative predictive value of PCT may be useful as an adjunct to urinalysis results to rule out UTI and facilitate noninitiation or earlier discontinuation of empiric antibiotics.
尿路感染（UTI）是女性在急诊科（ED）就诊的最常见原因之一。生物标志物降钙素原（PCT）在过去十年中越来越受欢迎，可改善细菌感染的诊断并减少不必要的抗生素暴露。PCT 已在肺炎和脓毒症患者中进行了广泛研究，并且在 UTI 中可能具有额外作用。
对在就诊的 ED 中进行了尿液分析测试和 PCT 水平检测的患者进行回顾性研究，这些患者在就诊的前 24 小时内进行了这些检测。回顾了 UTI 的体征和症状以及尿液培养结果，以确定 UTI 的阳性诊断。使用受试者工作特征曲线下的面积来计算 PCT 的测试特征。分析了不同的截断值，以确定与最高灵敏度和特异性相对应的 PCT 水平。
这项单中心回顾性研究共纳入 293 例患者。PCT 预测 UTI 的 AUC 为 0.717；95%CI：0.643-0.791（p<0.001）。PCT 阈值为 0.25ng/ml 时，灵敏度（67%）和特异性（63%）的组合最佳，阳性预测值和阴性预测值分别为 26%和 91%。
PCT 阈值<0.25ng/ml 是 UTI 不存在的有力预测指标。PCT 的高阴性预测值可作为尿液分析结果的辅助手段，用于排除 UTI 并促进经验性抗生素的非起始或更早停药。
