Title: Utility of Procalcitonin and C-reactive protein in diagnosing patients with urinary tract infections

Authors: Dr Virendrasinh Bhati, Dr Smita Patil

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i9.165

Abstract

Introduction: Urinary tract infection (UTI) is the inflammatory response of urothelium to bacterial invasion, is one of the most common infections in all ages of life. In this study, we aim to compare the levels of biomarkers among patients positive for UTI against those without UTI.

Methodology: This single centre, retrospective study included patients aged 18 years or above, who presented to the Emergency Department of DY Patil Hospital, Navi Mumbai and was tested with urinalysis and had urine culture, blood cultures, and samples for blood test were taken within 24 hours from which biomarkers like procalcitonin (PCT) and C-reactive protein (CRP) were evaluated. PCT was measured by quantitative electrochemiluminescence immunoassay with a sensitivity of 0.02 ng/ml and CRP was determined by quantitative enzyme immunoassay with a sensitivity of 1mg/l. All statistical tests were 2-tailed and a p < 0.05 met statistical significance.

Results: During the study period 247 patients were included, of which 62 patients were positive for UTI. We observed a significantly higher proportion of patients with previous history of UTI, urinary stones, fever and systolic blood pressure less than 90 mm of Hg among patients who were positive for UTI. We found higher PCT and CRP levels among patients with UTI (0.82 ± 0.15 ng/ml and 110.4 ± 12.8 mg/L respectively) as compared to those negative for UTI (0.11 ± 0.20 and 27.7 ± 8.16 respectively).

Conclusions: Serum procalcitonin and blood CRP measurements are non-invasive tests which can diagnose UTI in patients.

Keywords: Procalcitonin; C-reactive protein; Biomarkers; Urinary tract infection

References

  1. González-Chamorro F, Palacios R, Alcover J, Campos J, Borrego F, Dámaso D. La infección urinaria y su prevención. Actas Urol Esp. 2012;36:48-53.
  2. Julian-Jimenez A, Gutierrez-Martin P, Lizcano-Lizcano A, Lopez-Guerrero MA, Barroso-Manso A, Heredero-Galvez E. Usefulness of procalcitonin and C-reactive protein for predicting bacteremia in urinary tract infections in the emergency department. Actas Urológicas Españolas (English Edition). 2015 Oct 1;39(8):502-10.
  3. de Guadiana Romualdo LG, Torrella PE, González MV, Sánchez RJ, Holgado AH, Freire AO, Acebes SR, Otón MD. Diagnostic accuracy of presepsin (soluble CD14 subtype) for prediction of bacteremia in patients with systemic inflammatory response syndrome in the Emergency Department. Clinical biochemistry. 2014 May 1;47(7-8):505-8.
  4. Van Nieuwkoop C, Bonten TN, Van’t Wout JW, Kuijper EJ, Groen- eveld GH, Becker MJ, et al. Procalcitonin reflects bacteremia and bacterial load in urosepsis syndrome: a prospective obser- vational study. Crit Care. 2010;14:R206.
  5. Grace E, Turner RM. Use of procalcitonin in patients with various degrees of chronic kidney disease including renal replacement therapy. Clin Infect Dis. 2014 Dec 15;59(12):1761-7.
  6. Hernandez JG, Sunden F, Connolly J, Svanborg C, Wullt B. Genetic Control of the Variable Innate Immune Response to Asymptomatic Bacteriuria. PLoS ONE 2011;6(11):e28289.
  7. de Jong E, van Oers JA, Beishuizen A, Vos P, Vermeijden WJ, Haas LE, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis 2016;16(7):819-827.
  8. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;1;63(5):e 61 -e1 11.
  9. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med 2017;45(3):486 -55 2.
  10. Julián-Jiménez A, Laserna-Mendieta EJ, Timón-Zapata J, Cabezas-Martínez A. Importancia de la sospecha clínica y con- firmación de bacteriemia en los servicios de urgencias. Med Clin (Barc).2011;137:424-9.
  11. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580-637.
  12. Pecile P, Miorin E, Romanello C, Falleti E, Valent F, Giacomuzzi F, Tenore A: Procalcitonin: a marker of severity of acute pyelonephritis among children. Pediatrics. 2004, 114: e249-254.
  13. Knudsen JB, Fuursted K, Petersen E, Wierup P, Molgaard H, Poulsen SH, Egeblad H: Procalcitonin in 759 patients clinically suspected of infective endocarditis. Am J Med. 2010, 123: 1121-1127
  14. Drozdov D, Schwarz S, Kutz A, Grolimund E, Rast AC, Steiner D, et al. Procalcitonin and pyuria-based algorithm reduces antibiotic use in urinary tract infections: a randomized controlled trial. BMC Medicine 2015;13:104.
  15. Julián-Jiménez A, Candel-González FJ, González del Castillo J. Utilidad de los biomarcadores de inflamación e infección en los servicios de urgencias. Enferm Infecc Microbiol Clin. 2014;32:177-90.

Corresponding Author

Dr Smita Patil

Dept of General Medicine, D Y Patil University School of Medicine, Nerul, Navi Mumbai-400706, India