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J Korean Soc Emerg Med > Volume 30(1); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(1): 52-60.
급성 신우신염을 가진 여성 환자에서 균혈증을 예측하기 위한 초기 혈장 프로칼시토닌, 젖산 및 C-반응성 단백질의 진단 성능 비교
김병진1, 조시온1 , 이재백1, 진영호1, 정태오1, 윤재철1, 박보영2
1전북대학교병원 응급의학과
2한양대학교 의과대학 의학과
Comparison of the diagnostic performance of initial serum procalcitonin, lactate, and C-reactive protein for predicting bacteremia in female patients with acute pyelonephritis
Byoungjin Kim1, Sion Jo1 , Jae Baek Lee1, Youngho Jin1, Taeoh Jeong1, Jaechol Yoon1, Boyoung Park2
1Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju
2Department of Medicine, Hanyang University College of Medicine, Seoul, Korea
Correspondence  Sion Jo ,Tel: 063-250-1075, Fax: 063-250-1075, Email: akynei@naver.com,
Received: July 17, 2018; Revised: October 9, 2018   Accepted: October 10, 2018.  Published online: February 28, 2019.
The purpose of the present study was to compare the diagnostic performance of initial procalcitonin, lactate, and high-sensitive C-reactive protein (hsCRP) for predicting bacteremia in female patients with acute pyelonephritis (APN).
We conducted a retrospective study of female APN patients who visited the emergency department (ED) at the studied hospital between January 2015 and December 2016. The main outcome was bacteremia, which was reported via the first blood culture at ED. The patient demographics, co-morbidities, physiologies, and laboratory variables including initial procalcitonin, lactate, and hsCRP levels, were collected and analyzed to identify associations with the presence of bacteremia. The area under the receiver operating curve (AUROC) and sensitivity (SE)/specificity (SP) were calculated for each variable.
During the study period, 282 patients were enrolled. A total of 105 (37.2%) patients had bacteremia. Escherichia coli was the most frequent pathogen. The AUROC was 0.70 (0.63-0.76), 0.70 (0.63-0.76), and 0.56 (0.49- 0.63) for the procalcitonin, lactate, and hsCRP, respectively. At a cut-off value of 0.163 ng/mL, the procalcitonin level predicted bacteremia, with a SE /SP of 95.2%/22.6%, respectively. At a cut-off value of 0.7 mmol/L, the lactate level predicted bacteremia with a SE/SP of 96.2%/20.9%, respectively. The combination of a procalcitonin level >0.447 ng/mL or a lactate level >0.7 mmo/L was chosen, as they showed 100% SE and a 100% negative predictive value.
The initial serum procalcitonin and lactate levels showed similar and fair discriminative performance for predicting bacteremia in female APN patients, while the hsCRP level showed poor performance. The combination of procalcitonin and lactate (procalcitonin level≤0.447 ng/mL and lactate≤0.7 mmol/L) can be used to identify patients at low risk of bacteremia.
Key words: Procalcitonin; Lactic acid; C-reactive protein; Acute pyelonephritis; Bacteremia
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