Plasma procalcitonin and urine interleukin-8, neutrophil gelatinase–associated lipocalin, and calprotectin in the diagnostic process of a urinary tract infection at the emergency department

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES International Journal of Infectious Diseases Pub Date : 2024-10-05 DOI:10.1016/j.ijid.2024.107257
Stephanie J.M. Middelkoop , Robert Keekstra , L․Joost van Pelt , Greetje A. Kampinga , Anneke C. Muller Kobold , Jan C. ter Maaten , Coen A. Stegeman
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Abstract

Objectives

This study aimed to assess the usefulness of plasma procalcitonin and urine IL-8 (interleukin-8), NGAL (neutrophil gelatinase–associated lipocalin), and calprotectin for diagnosis of urinary tract infections (UTIs) at the emergency department (ED).

Methods

In adults presenting at the ED with UTI suspicion, biomarker performance was compared with that of routine diagnostics (urine dipstick, automated urinalysis). Patients with a urine catheter, leukopenia, or neither (standard) were analyzed separately.

Results

A UTI was clinically diagnosed in 91 of 196 episodes (46.4%) (standard: 29/67 [43.2%]; catheter: 46/73 [63.0%]; leukopenia: 17/60 [28.3%]; four patients had both). Procalcitonin did not discriminate between UTI and no UTI. Urinary biomarker levels were elevated in UTI episodes (median, µg/mmol creatinine: NGAL, 7.8 vs 46.3; IL-8, 6.1 vs 76.6; calprotectin, 23.9 vs 265.4); the three subgroups also had higher levels. Biomarker cut-off values (90% sensitivity) showed low specificity (range 20.8-64.9%) and moderate accuracy (58.6-75.4%). The biomarkers performed similarly to routine diagnostics, except for patients with leukopenia, who exhibited nonsignificantly higher area under the curve values. All urinary biomarkers correlated positively with urine leukocyte count.

Conclusion

Plasma procalcitonin could not accurately diagnose UTI. Urine IL-8, NGAL, and calprotectin showed no additional value relative to routine diagnostics, except a minor improvement in patients with leukopenia. These urine biomarkers seem to predominantly reflect leukocyturia.
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急诊科尿路感染诊断过程中的血浆降钙素原、尿液白细胞介素-8、中性粒细胞明胶酶相关脂联素和钙蛋白。
目的评估血浆降钙素原和尿液中白细胞介素-8(IL-8)、中性粒细胞明胶酶相关脂联素(NGAL)和钙黏蛋白对急诊科(ED)诊断尿路感染(UTI)的作用:方法:在急诊科就诊的疑似UTI成人中,将生物标记物的性能与常规诊断(尿液浸量尺、自动尿液分析仪)进行比较。对使用导尿管、白细胞减少或两者都没有(标准)的患者分别进行分析:临床诊断为尿毒症的有 91/196 例(46.4%);标准:29/67 例(43.2%),导尿管 46/73 例(63.0%),白细胞减少 17/60 例(28.3%)(4 例同时患有两种疾病)。降钙素原不能区分尿毒症和非尿毒症。尿毒症患者的尿液生物标志物水平升高(中位数,微克/毫摩尔肌酐):NGAL 7.8 vs. 46.3,IL-8 6.1 vs. 76.6,钙蛋白 23.9 vs. 265.4;三个亚组的水平也较高。生物标志物的临界值(灵敏度为 90%)显示出较低的特异性(范围为 20.8%-64.9%)和中等的准确性(58.6%-75.4%)。除白细胞减少症患者的 AUC 值明显较高外,其他生物标记物的表现与常规诊断结果相当。所有尿液生物标记物均与尿白细胞计数呈正相关:结论:血浆降钙素原不能准确诊断尿毒症。尿液中的 IL-8、NGAL 和 calprotectin 对常规诊断没有额外价值,只是在白细胞减少的患者中略有改善。这些尿液生物标志物似乎主要反映白细胞尿。
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来源期刊
CiteScore
18.90
自引率
2.40%
发文量
1020
审稿时长
30 days
期刊介绍: International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.
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