Can procalcitonin reduce unnecessary voiding cystoureterography in children with first febrile urinary tract infection?

ABSTRACT

Recently, new predictors of vesicoureteral reflux [VUR] in children with a first febrile UTI such as Procalcitonin [PCT] were introduced as selective approaches for cystography. This study wants to show the capability of PCT in predicting presence of VUR at the first febrile UTI in children. Patients between 1 month and 15 years of age with febrile UTI were included in this prospective study. PCT values were measured through a semi-quantitative method in four grades comprising values less than 0.5, 0.5-2.0, 2.0-10.0 and above 10.0 ng/ml. The independence of PCT levels in predicting VUR were assessed after adjustment for all potential confounders using a logistic-regression model. A total of 68 patients, 54 [79.4%] girls and 14 [20.6%] boys were evaluated. PCT level demonstrated a significant difference between patients with positive VUR and those with negative VUR [P=0.012]. To calculate the independent factors that may predict the presence of VUR, all included variables were adjusted for age and sex. Results of logistic regression showed that a PCT level between 2.0 and 10.0 ng/mL could independently predict presence of VUR [Odds ratio=6.11, CI 95%= 1.22-30.77, P=0.03]. Our finding in this study showed that readily available semi-quantitative measures for PCT are feasible for detecting patients with VUR. We suggest that in semi-quantitative measurements of PCT, levels between 2.0 and 10.0 ng/ml could be an independent predictor of positive VUR