Abstract:

Objective To explore the diagnositc value and association with procalcitonin(PCT) in children with urinary tract infection and vesicoureteral reflux(VUR). Methods From Jan 1st 2012 to Dec 31st. 2015, children admitted with the first urinary tract infection from in-patient of one hospital were recruited in the study, all the patients performed the detection of PCT, CRP, VCUG and urine bacterial culture. Children with hospital acquired urinary tract infection, or experienced with urinary tract operation were excluded. All patients were divided into non-VUR group and VUR group(including mild VUR subgroup and severe VUR subgroup), as well as sequential grades according the results of VCUG(gold standard). Data of PCT, CRP(detected within 24 h of admission), urine bacterial culture, ultrasonography of the urinary system, voiding cystourethrography（VCUG）were collected for analyzing. Diagnositic performances of PCT and CRP in VUR were compared. Results Among 156 children included, 58 had VUR (including 38 cases of mild VUR and 20 cases of severe VUR),98 had no VUR, there was no difference in age and sex between VUR and non-VUR groups（Z=-1.667, P=0.096；χ2=0.291，P=0.590）. Levels of PCT (ng·mL-1) and CRP (mg·L-1) in the VUR group［1.01（0.78，1.28）vs 0.40（0.10,0.60）；14.2（8.9,31.1）vs 11.0（6.6,19.5）］ were significantly higher than the non-VUR group（Z=-7.863, P=0.000；Z=-2.327, P=0.02）. There were statisitical differences in PCT level among groups of non-VUR, mild VUR subgroup［0.99（0.68,1.16）］, and severe VUR subgroup［1.57（0.93,1.96）］. There were statisitical differences in CRP level between groups of non-VUR and severe VUR subgroup［28.9（12.7,45.2）］. There were statisitical differences in PCT and CRP level between mild VUR subgroup and severe VUR subgroup. But there was no statisitical difference in CRP level between non-VUR and mild VUR subgroups［12.6（8.5,19.5）］. The best cutoff of PCT to discriminate VUR and non-VUR was 0.77 ng·mL-1, with the sensitivity of 77.6%, specificity of 90.8%, AUC ROC of 0.877(0.811~0.943). After adjusting for sex, CRP and other confounding factors, the risk of children with PCT≥0.77 ng·mL-1 was 3.604 times higher than children with PCT＜0.77 ng·mL-1. Conclusion Procalcitonin may play a role in determining the presence of vesicoureteral reflux in children with urinary tract infections, and may be independently used to predict the VUR.