Serum procalcitonin to differentiate acute antepartum pyelonephritis from asymptomatic bacteriuria and acute cystitis during pregnancy: A multicenter prospective observational study

Abstract

Objective: To examine whether serum procalcitonin (PCT) is useful for differentiating acute pyelonephritis (APN) from asymptomatic bacteriuria and acute cystitis during pregnancy. Methods:A multicenter prospective observational study was conducted to compare serum white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and PCT level among pregnant women with asymptomatic bacteriuria, acute cystitis, and APN and healthy pregnant women (controls).Utility of WBC count, ESR, CRP, and PCT biomarkers for the prediction of APN during pregnancy were measured.Results: Area under the curve (AUC) values of PCT, CRP, ESR, and WBC count for predicting asymptomatic bacteriuria were 0.576, 0.628, 0.542, and 0.532, respectively; those for predicting acute cystitis were 0.766, 0.735, 0.681, and 0.597, respectively; and those for predicting acute pyelonephritis 0.859, 0.763, 0.711, and 0.732, respectively. Compared with the other inflammatory markers used to predict APN, PCT exhibited the highest AUC (0.859 [95% confidence interval (CI) 0.711-0.935]). A cutoff value of >0.25 ng/ml had a sensitivity of 87% and a specificity of 79%. Conclusion:Serum PCT can be a valuable addition to existing methods of differentiating asymptomatic bacteriuria, acute cystitis, and APN during pregnancy and can facilitate the early identification of APN during pregnancy.

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“…Previous research revealed that PCT levels were similar in pregnant and nonpregnant women, and the upper reference limit for PCT was 0.05 ng/mL for any observed gestational age group 21 . A multicentre prospective observational study showed that a cut‐off value of serum PCT > 0.25 ng/mL had a sensitivity of 87% and a specificity of 79% and was a better biomarker than CRP and leukocytes in differentiating acute pyelonephritis from asymptomatic bacteriuria and acute cystitis in pregnancy 22 . However, a recent study demonstrated that maternal serum CRP was a better predictive biomarker of histological chorioamnionitis than PCT 23 …”

“…21 A multicentre prospective observational study showed that a cut-off value of serum PCT > 0.25 ng/mL had a sensitivity of 87% and a specificity of 79% and was a better biomarker than CRP and leukocytes in differentiating acute pyelonephritis from asymptomatic bacteriuria and acute cystitis in pregnancy. 22 However, a recent study demonstrated that maternal serum CRP was a better predictive biomarker of histological chorioamnionitis than PCT. 23 In our study, the three traditional biomarkers (leukocytes, CRP and PCT) in the bacterial infection group were significantly higher than those in the influenza A group.…”

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“…As a result, looking for more reliable and precise early-stage indicators is of paramount importance in reducing severity and maternal as well as fetal mortality. Recently, procalcitonin (PCT), the existence of leukocytosis, thrombocytosis, etc have been regarded as emerging prognostic predictors, although the exact accuracy and prognostic value have not been fully elucidated [ 5 ].…”