Predictive Value of Serum Procalcitonin in Urinary Tract Infection Patients with Bacteremia

ABSTRACT

PURPOSE: Urinary tract infection (UTI) is a common disease in the emergency department (ED). In general, UTI could be treated easily without complication. However, UTI with bacteremia can progress to sepsis or severe sepsis and delay of appropriate treatment can result in worse prognosis. Increased serum procalcitonin level in the bacterial infection of ED patients has been proven. The purpose of this study is to examine the clinical utility of procalcitonin as a predictor for bacteremia in UTI patients in the ED setting. METHODS: This is a retrospective cohort study. UTI Patients admitted through the ED of three academic teaching hospitals from January 2010 to December 2012 were enrolled. We investigated demographic characteristics, hemodynamic variables, and laboratory results including serum procalcitonin level at presentation to the ED according to the presence of bacteremia. ROC curve was obtained and multivariate regression analysis was performed to test the predictive value of serum procalcitonin level for bacteremia in UTI patients. RESULTS: A total of 334 patients were enrolled. Bacteremia was proven in 135 UTI patients. UTI patients with bacteremia had significantly higher serum level of procalcitonin (0.830 vs. 6.860, p<0.0001). In multivariable logistic regression analysis, level of procalcitonin and platelet count showed statistical significance (Odds Ratio=1.018, (1.007-1.028), 0.995, (0.992-0.998), 95% CI). Area under the curve for procalcitonin was 0.729, and cut off value was 2.52 ng/ml. CONCLUSION: Serum procalcitonin level could be used as a valuable predictor for the presence of bacteremia in UTI patients visiting the ED.