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
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...
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Elsevier
2024-12-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S120197122400328X |
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| author | Stephanie J.M. Middelkoop Robert Keekstra L․Joost van Pelt Greetje A. Kampinga Anneke C. Muller Kobold Jan C. ter Maaten Coen A. Stegeman |
| author_facet | Stephanie J.M. Middelkoop Robert Keekstra L․Joost van Pelt Greetje A. Kampinga Anneke C. Muller Kobold Jan C. ter Maaten Coen A. Stegeman |
| author_sort | Stephanie J.M. Middelkoop |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-4c7ae3ac1982419a96041e40d52fa09f |
| institution | OA Journals |
| issn | 1201-9712 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj-art-4c7ae3ac1982419a96041e40d52fa09f2025-08-20T02:07:01ZengElsevierInternational Journal of Infectious Diseases1201-97122024-12-0114910725710.1016/j.ijid.2024.107257Plasma procalcitonin and urine interleukin-8, neutrophil gelatinase–associated lipocalin, and calprotectin in the diagnostic process of a urinary tract infection at the emergency departmentStephanie J.M. Middelkoop0Robert Keekstra1L․Joost van Pelt2Greetje A. Kampinga3Anneke C. Muller Kobold4Jan C. ter Maaten5Coen A. Stegeman6University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, Groningen, The Netherlands; Corresponding author: Tel.: +31 50 361 29 55.University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Groningen, The NetherlandsUniversity of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Groningen, The NetherlandsUniversity of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The NetherlandsUniversity of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Groningen, The NetherlandsUniversity of Groningen, University Medical Center Groningen, Department of Acute Care, Groningen, The NetherlandsUniversity of Groningen, University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, Groningen, The NetherlandsObjectives: 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.http://www.sciencedirect.com/science/article/pii/S120197122400328XUrinary tract infectionEmergency medicineBiomarkersAutomated urinalysisUrine dipstick |
| spellingShingle | Stephanie J.M. Middelkoop Robert Keekstra L․Joost van Pelt Greetje A. Kampinga Anneke C. Muller Kobold Jan C. ter Maaten Coen A. Stegeman 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 International Journal of Infectious Diseases Urinary tract infection Emergency medicine Biomarkers Automated urinalysis Urine dipstick |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Urinary tract infection Emergency medicine Biomarkers Automated urinalysis Urine dipstick |
| url | http://www.sciencedirect.com/science/article/pii/S120197122400328X |
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