응급센터로 내원한 요로감염 환자에게서 균혈증 동반여부를 예측하기 위한 혈청프로칼시토닌 측정의 유용성

Abstract

Purpose: Urinary tract infection (UTI) is a common diseasein the emergency department (ED). In general, UTI couldbe treated easily without complication. However, UTI withbacteremia can progress to sepsis or severe sepsis anddelay of appropriate treatment can result in worse prognosis. Increased serum procalcitonin level in the bacterialinfection of ED patients has been proven. The purpose ofthis study is to examine the clinical utility of procalcitonin asa predictor for bacteremia in UTI patients in the ED setting. Methods: This is a retrospective cohort study. UTI Patientsadmitted through the ED of three academic teaching hospitalsfrom January 2010 to December 2012 were enrolled. We investigated demographic characteristics, hemodynamicvariables, and laboratory results including serum procalcitoninlevel at presentation to the ED according to the presenceof bacteremia. ROC curve was obtained and multivariateregression analysis was performed to test the predictivevalue of serum procalcitonin level for bacteremia inUTI patients. Results: A total of 334 patients were enrolled. Bacteremiawas proven in 135 UTI patients. UTI patients with bacteremiahad significantly higher serum level of procalcitonin(0.830 vs. 6.860, p<0.0001). In multivariable logistic regressionanalysis, level of procalcitonin and platelet countshowed statistical significance (Odds Ratio=1.018, (1.007-1.028), 0.995, (0.992-0.998), 95% CI). Area under thecurve for procalcitonin was 0.729, and cut off value was2.52 ng/ml. Conclusion: Serum procalcitonin level could be used as avaluable predictor for the presence of bacteremia in UTIpatients visiting the ED.