Abstract
BackgroundA new serum marker of inflammation copeptin (CPP) a stable C-terminal pro-vasopressin was assessed along with conventional markers such as C-reactive protein (CRP), procalcitonin (PCT) and IL-6 to discriminate between lower and upper bacterial urinary tract infections (UTI).MethodsStudy population comprised 45 patients including 13 with lower UTI (L-UTI) and 32 with upper UTI (U-UTI) and 24 healthy controls. Serum markers, blood cultures and urine cultures were assessed before commencing antibiotic treatment and repeated 24, 48 h and 7 days thereafter. Receiver operating curves (ROC) were plotted to assess a diagnostic utility of different inflammatory markers.ResultsBefore antibiotic therapy all inflammatory markers including serum CPP (2821.1 ± 1072.4 pg/ml vs. 223.8 ± 109.3 pg/ml; p < 0.05) were higher in UTI than in controls. CPP was not different between L- and U-UTI (2253 ± 1323 pg/ml vs 3051 ± 1178 pg/ml; p = 0.70) despite significant differences in hsCRP (2.09 ± 1.7 mg/dl vs 127.3 ± 62.4 mg/dl; p < 0.001), PCT (0.05 ± 0 vs 5.02 ± 0.03 ng/ml p < 0.001) and IL-6 (22.5 ± 1.6 vs 84.8 ± 67 pg/ml p < 0.001). For U-UTI the areas under the ROC curves were 1.0 for both hsCRP and CPP, 0.94 for PCT and 0.7 for IL-6 and for L-UTI 0.571, 1, 0.505 and 0.73, respectively. After 7 days of treatment all markers decreased in parallel to clinical response.ConclusionAlthough elevated serum copeptin may become a marker of UTI it seems to be inferior compared to traditional serum inflammation markers for differentiation of bacterial infections involving upper and lower urinary tract.
Highlights
A new serum marker of inflammation copeptin (CPP) a stable C-terminal pro-vasopressin was assessed along with conventional markers such as C-reactive protein (CRP), procalcitonin (PCT) and IL-6 to discriminate between lower and upper bacterial urinary tract infections (UTI)
Patients The subjects for this single-center observational, prospective study were recruited from the patients manifesting symptoms of UTI who were consecutively admitted to our hospital from May 2011 through September 2012 and diagnosed with acute pyelonephritis, as well as among patients with symptoms of lower UTI (L-UTI) who were treated in our outpatient department
In our study a number of blood leucocytes, serum C-reactive protein (hsCRP), PCT, IL-6 and CPP significantly increased in patients with UTI compared to healthy subjects
Summary
A new serum marker of inflammation copeptin (CPP) a stable C-terminal pro-vasopressin was assessed along with conventional markers such as C-reactive protein (CRP), procalcitonin (PCT) and IL-6 to discriminate between lower and upper bacterial urinary tract infections (UTI). The part of the urinary tract involved, i.e., low or upper UTI needs to be quickly established this is not always possible if based on clinical symptoms only. In most cases clinical symptoms of upper UTI (U-UTI) are dominated by fever and side pain [1]. In the latter an accurate diagnosis and early treatment is crucial due to a risk of urosepsis and long-term consequences including chronic kidney disease [2, 3]. Despite its dominant role in cardiovascular disease, the measurement and diagnostic application of vasopressin have never been found useful in clinical practice due to methodological problems caused by its short half-life, functional interactions with platelets in serum and small molecular size [6, 7]
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