You have accessJournal of UrologyStone Disease: Evaluation II1 Apr 2015MP80-20 PROCALCITONIN SHOWS SUPERIOR SPECIFICITY IN PREDICTING INFECTION IN THE SETTING OF OBSTRUCTIVE URETERAL CALCULI Dimitri Papagiannopoulos, Patrick Whelan, Waseem Ahmad, James Rybak, Dino Rumoro, Leslie Deane, and Ajay Nehra Dimitri PapagiannopoulosDimitri Papagiannopoulos More articles by this author , Patrick WhelanPatrick Whelan More articles by this author , Waseem AhmadWaseem Ahmad More articles by this author , James RybakJames Rybak More articles by this author , Dino RumoroDino Rumoro More articles by this author , Leslie DeaneLeslie Deane More articles by this author , and Ajay NehraAjay Nehra More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2856AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urosepsis represents a severe systemic infection originating from the urinary tract with a mortality rate approaching 20%. The majority of these cases result from obstructing ureteral calculi. The appropriate management is prompt genitourinary decompression, but infections are difficult to predict, as symptoms may not correlate with severity of disease. Procalcitonin (PCT) is a biomarker that has shown promise in predicting degree of infection and differentiating bacterial from viral or non-specific inflammatory etiologies. The objective of this study is to determine if PCT is a relevant, surrogate biomarker for predicting infections in obstructing upper urinary tract ureteral calculi, and whether it can help guide timing of surgical intervention in clinically borderline cases. METHODS This is a single-institution pilot study examining adult patients who presented to the ED with acute obstructing ureterolithiasis. In total 22 patients were enrolled between February and August 2014. At the time of presentation the following data was obtained: vital signs, white blood cell (WBC) count, PCT, C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), urinalysis, urine and blood cultures. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for WBC count, PCT, CRP, and ESR in predicting sepsis, and positive urine or blood cultures. RESULTS Of the 22 patients presenting with obstructing ureteral stones, 3 patients met the criteria for sepsis, 2 patients had positive blood cultures, and 6 patients had positive urine cultures. CONCLUSIONS PCT has a superior specificity in predicting sepsis and positive cultures compared to WBC count, ESR and CRP. In clinically borderline cases, PCT may have utility in determining whether sepsis or urinary tract infections are present. Ultimately, this may help determine duration of antibiotics, timing of decompression and timing of definitive stone management. Table 1. Predicting Sepsis Sensitivity Specificity PPV NPV PCT 0.67 0.89 0.5 0.94 WBC 1.0 0.58 0.27 1.0 ESR 0.67 0.61 0.22 0.92 CRP 1.0 0.68 0.25 1.0 Table 2. Predicting positive cultures (blood and/or urine) Sensitivity Specificity PPV NPV PCT 0.67 0.89 0.67 0.89 WBC 0.67 0.56 0.36 0.82 ESR 0.67 0.67 0.44 0.83 CRP 0.60 0.75 0.43 0.86 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1027 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dimitri Papagiannopoulos More articles by this author Patrick Whelan More articles by this author Waseem Ahmad More articles by this author James Rybak More articles by this author Dino Rumoro More articles by this author Leslie Deane More articles by this author Ajay Nehra More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...