Prognostic value of pro-adrenomedullin, procalcitonin and C-reactive protein in predicting outcome of febrile urinary tract infection

Abstract

Bacterial infections such as febrile urinary tract infection (fUTI) may run a complicated course that is difficult to foretell on clinical evaluation only. Because the conventional biomarkers erythrocyte sedimentation rate (ESR), leucocyte count, C-reactive protein (CRP) and procalcitonin (PCT) have a limited role in the prediction of a complicated course of disease, a new biomarker-plasma midregional pro-adrenomedullin (MR-proADM)-was evaluated in patients with f UTI. We conducted a prospective multicentre cohort study including consecutive patients with f UTI at 35 primary-care centres and eight emergency departments. Clinical and microbiological data were collected and plasma biomarker levels were measured at presentation to the physician. Survival was assessed after 30 days. Of 494 fUTI patients, median age was 67 (interquartile range 49-78) years, 40% were male; two-thirds of them had significant co-existing medical conditions. Median MR-proADM level was 1.42 (interquartile range 0.67-1.57) nM; significantly elevated MR-proADM levels were measured in patients with bacteraemia, those admitted to the intensive care unit, and in 30-day and 90-day non-survivors, compared with patients without these characteristics. The diagnostic accuracy for predicting 30-day mortality in fUTI, reflected by the area-under-the-curve of receiver operating characteristics were: MR-proADM 0.83 (95% CI 0.71-0.94), PCT 0.71 (95% CI 0.56-0.85); whereas CRP, ESR and leucocyte count lacked diagnostic value in this respect. This study shows that MR-proADM assessed on first contact predicts a complicated course of disease and 30-day mortality in patients with fUTI and in this respect has a higher discriminating accuracy than the currently available biomarkers ESR, CRP, PCT and leucocyte count.

Trend of Erythrocyte Sedimentation Rate in Patients with Symptomatic Urinary Tract Infection Under Treatment

“…Also, other studies have shown that ESR and leucocyte count don't have a great value in predicting outcome of febrile UTI (10,11). The results of our study and similar studies demonstrate that ESR changes relatively slowly as the patient's condition improves (12).…”

“…Although serial measurement of ESR level has been advocated for monitoring of disease processes in adulthood infections, most recent studies tend to favor pro-adrenomedullin, procalcitonin, and C-reactive protein over ESR, mainly because of the fact that ESR is affected by a multitude of factors (10).…”

External validation of the STONE score and derivation of the modified STONE score

“…Half of ureter stones recur within 5 years. A low CRP might exclude other infectious conditions, such as acute pyelonephritis or renal abscess [22]. C-reactive protein could also be used as a predictor of spontaneous passage of ureter stones.…”

Pro-Adrenomedullin predicts 10-year all-cause mortality in community-dwelling patients: a prospective cohort study

“…In the setting of primary care, in smaller studies ProADM was associated with mortality in patients with urinary tract infections [43], type 2 diabetes [43–45] or heart failure [25, 46–49]. It is not known whether this marker helps to predict long-term risk, which could be useful for directing preventive measures.…”