Pediatric UTI Association of Procalcitonin With Acute Pyelonephritis and Renal Scars in

abstract BACKGROUNDANDOBJECTIVE:Urinarytractinfections(UTIs)arecom-monchildhoodbacterialinfectionsthatmayinvolverenalparenchymalinfection (acute pyelonephritis [APN]) followed by late scarring.Prompt, high-quality diagnosis of APN and later identification ofchildren with scarring are important for preventing future complications.Examination via dimercaptosuccinic acid scanning is the current clinicalgold standard but is not routinely performed. A more accessible assaycould therefore prove useful. Our goal was to study procalcitonin asa predictor for both APN and scarring in children with UTI.METHODS: A systematic review and meta-analysis of individual patientdatawereperformed;alldataweregatheredfromchildrenwithUTIswhohadundergonebothprocalcitoninmeasurementanddimercaptosuccinicacid scanning.RESULTS: A total of 1011 patients (APN in 60.6%, late scarring in 25.7%)wereincludedfrom18studies.Procalcitoninasacontinuous,class,andbinary variable was associated with APN and scarring (P , .001) anddemonstrated a significantly higher (P , .05) area under the receiveroperating characteristic curve than either C-reactive protein or whiteblood cell count for both pathologies. Procalcitonin $0.5 ng/mL yieldedan adjusted odds ratio of 7.9 (95% confidence interval [CI]: 5.8–10.9)with 71% sensitivity (95% CI: 67–74) and 72% specificity (95% CI: 67–76)for APN. Procalcitonin $0.5 ng/mL was significantly associated withlate scarring (adjusted odds ratio: 3.4 [95% CI: 2.1–5.7]) with 79%sensitivity (95% CI: 71–85) and 50% specificity (95% CI: 45–54).CONCLUSIONS: Procalcitonin was a more robust predictor comparedwith C-reactive protein or white blood cell count for selectivelyidentifying children who had APN during the early stages of UTI, aswell as those with late scarring. Pediatrics 2013;131:870–879