Prognostic value of pro-adrenomedullin, procalcitonin and C-reactive protein in predicting outcome of febrile urinary tract infection

Prognostic value of pro-adrenomedullin, procalcitonin and C-reactive protein in predicting outcome of febrile urinary tract infection

Bacterial infections such as febrile urinary tract infection (fUTI) may run a complicated course that is difficult to foretell on clinical evaluation only. Because the conventional biomarkers erythrocyte sedimentation rate (ESR), leucocyte count, C-reactive protein (CRP) and procalcitonin (PCT) have...

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Published in:Clinical microbiology and infection Vol. 20; no. 10; pp. 1048 - 1054
Main Authors: van derStarre, W.E., Zunder, S.M., Vollaard, A.M., van Nieuwkoop, C., Stalenhoef, J.E., Delfos, N.M., van‘tWout, J.W., Spelt, I.C., Blom, J.W., Leyten, E.M.S., Koster, T., Ablij, H.C., van Dissel, J.T.
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01-10-2014
Elsevier Limited
Subjects:
Adrenomedullin - blood
Aged
Biomarkers - blood
C-reactive protein
C-Reactive Protein - metabolism
Calcitonin - blood
Calcitonin Gene-Related Peptide
erythrocyte sedimentation rate
Female
Fever - blood
Fever - complications
Fever - microbiology
Fever - mortality
Humans
leucocyte count
Male
Middle Aged
pro-adrenomedullin
procalcitonin
Prognosis
Prospective Studies
Protein Precursors - blood
pyelonephritis
Risk Factors
Survival Analysis
urinary tract infection
Urinary Tract Infections - blood
Urinary Tract Infections - microbiology
Urinary Tract Infections - mortality
erythrocyte sedimentation rate
leucocyte count
pyelonephritis
C-reactive protein
procalcitonin
pro-adrenomedullin
urinary tract infection
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Summary:Bacterial infections such as febrile urinary tract infection (fUTI) may run a complicated course that is difficult to foretell on clinical evaluation only. Because the conventional biomarkers erythrocyte sedimentation rate (ESR), leucocyte count, C-reactive protein (CRP) and procalcitonin (PCT) have a limited role in the prediction of a complicated course of disease, a new biomarker—plasma midregional pro-adrenomedullin (MR-proADM)—was evaluated in patients with f UTI. We conducted a prospective multicentre cohort study including consecutive patients with f UTI at 35 primary-care centres and eight emergency departments. Clinical and microbiological data were collected and plasma biomarker levels were measured at presentation to the physician. Survival was assessed after 30 days. Of 494 fUTI patients, median age was 67 (interquartile range 49-78) years, 40% were male; two-thirds of them had significant co-existing medical conditions. Median MR-proADM level was 1.42 (interquartile range 0.67-1.57) nM; significantly elevated MR-proADM levels were measured in patients with bacteraemia, those admitted to the intensive care unit, and in 30-day and 90-day non-survivors, compared with patients without these characteristics. The diagnostic accuracy for predicting 30-day mortality in fUTI, reflected by the area-under-the-curve of receiver operating characteristics were: MR-proADM 0.83 (95% CI 0.71-0.94), PCT 0.71 (95% CI 0.56-0.85); whereas CRP, ESR and leucocyte count lacked diagnostic value in this respect. This study shows that MR-proADM assessed on first contact predicts a complicated course of disease and 30-day mortality in patients with fUTI and in this respect has a higher discriminating accuracy than the currently available biomarkers ESR, CRP, PCT and leucocyte count.
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ISSN:1198-743X
1469-0691
DOI:10.1111/1469-0691.12645