The procalcitonin/albumin ratio as an early diagnostic predictor in discriminating urosepsis from patients with febrile urinary tract infection

Abstract

Discrimination between urosepsis and febrile urinary tract infections is important in therapeutic decision-making to indicate suitable treatments to avoid sepsis-related organ failure. Accurate diagnosis is time-consuming and susceptible to false-positive results. Moreover, patient responses to urosepsis are complex and varied. Therefore, this study aimed to develop a new, early diagnostic predictor that could discriminate between patients with urosepsis and those with febrile urinary tract infections using a combination of initial procalcitonin and albumin levels.We conducted a retrospective study involving 140 patients with febrile urinary tract infections from January 2013 to December 2017. Univariate and multivariate logistic analyses were performed to identify the independent risk factors for differentiating urosepsis from febrile urinary tract infection. A receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive accuracy of the procalcitonin/albumin ratio.Patients in the urosepsis group had higher procalcitonin/albumin ratios compared to those in the febrile urinary tract infection group [2.254 (0.978, 6.299) vs 0.021 (0.004, 0.095); P < .001]. Based on multivariate logistic analysis, the procalcitonin/albumin ratio [adjusted odds ratio (OR) 1.029, 95% confidence interval (CI) 1.013–1.045, P < .001] was an independent predictor of urosepsis, which allowed for differentiation from patients with febrile urinary tract infections. The area under the ROC curve (AUC) for the procalcitonin/albumin ratio was 0.937 (95% CI, 0.894–0.980); P < .001. The sensitivity and specificity of the procalcitonin/albumin ratio cut-off values (>0.44) were 84.62% and 96.00%, respectively. Moreover, in the subset of 65 patients with urosepsis, the procalcitonin/albumin ratio in the uroseptic shock group was higher than in the group of patients without uroseptic shock [5.46 (1.43, 6.58) vs 1.24 (0.63, 4.38); P = .009].Our study demonstrates that the procalcitonin/albumin ratio is an early diagnostic predictor that can discriminate between urosepsis and febrile urinary tract infection. Additionally, in patients with urosepsis, those with higher procalcitonin/albumin ratios were more prone to uroseptic shock. Our findings suggest that the procalcitonin/albumin ratio is a rapid and relatively low-cost biomarker that can be used in clinical practice.

The Urosepsis—A Literature Review

“…Currently, the determination of procalcitonin is widely used by clinicians; however, there are a number of limitations generated mainly by the induction of procalcitonin expression by non-infectious diseases [36,37]. A procalcitonin/albumin ratio exceeding 0.44 is valuable for discriminating urosepsis from complicated urinary tract infection and may be superior to traditional biomarkers such as C-reactive protein and leukocyte count [38]. Mid-regional proadrenomedullin (MR-proADM) is a multi-tissue peptide to stabilize microcirculation and protect against endothelial permeability [39], both of which are recognized as having a significant role in the host's pathophysiological response to sepsis.…”

Nephrotoxicity of Herbal Medicine and Its Prevention

“…Rheum palmatum L. and its anthraquinone compounds can cause renal damage under certain conditions (Yan et al, 2006; increased with high sensitivity in the preclinical AKI model, up regulated expression in AKI, renal fibrosis, renal cell carcinoma and other models (Vinken et al, 2012) uTP glomerulus predicted early glomerular injury sensitively and specifically, widely used in the prevention and monitoring of kidney diseases in clinical research (Peterson et al, 1969) b2-MG Proximal convoluted tubule; glomerulus the monomer form of it can be filtered through glomerulus and reabsorbed by proximal convoluted tubular cells; limited in clinical application due to its instability in acidic urine (Schaub et al, 2005) cystatin C Proximal convoluted tubule; glomerulus; distal convoluted tubules; collecting duct passed glomerular filtration and reabsorbed by proximal convoluted tubular cells; reflected renal tubular dysfunction due to its increase in urine (Waring and Moonie, 2011;de Geus et al, 2012;Pianta et al, 2017) Kim-1 Proximal convoluted tubule used in preclinical and clinical acute renal injury studies, up regulated expression in AKI, renal fibrosis and other preclinical and clinical models (Ichimura et al, 2008;Waring and Moonie, 2011;de Geus et al, 2012) TFF-3 Proximal convoluted tubule mainly expressed in intestinal and renal tissues, increased expression and activity in ulcer tissue (Xing et al, 2013;Wang et al, 2019) albumin Proximal convoluted tubule; glomerulus also increased expression in the state of inflammation, bleeding, urinary tract infections, fever or stress. not a specific index of nephrotoxicity, needs to be combined with other markers (Schött et al, 2018;Luo et al, 2018a;Fernańdez et al, 2019) RPA-1 collecting duct predicted the early toxicity of renal papilla and has a good correlation with the degree of renal papilla injury (Betton et al, 2012) NGAL renal tubule; collecting duct considered to be a good marker of acute renal injury, and also a powerful early marker to assist the diagnosis of AKI and CKD. Increased the serum NGAL level in the state of inflammation and infection…”

Clinical and Laboratory Characteristics and Differential Diagnosis between Secondary Hemophagocytic Syndrome and Sepsis

“…Снижение уровня альбумина в большей степени свидетельствует о системном воспалении и мало зависит от нутритивного статуса, как принято полагать [42]. Так, по данным разных авторов, уровни альбумина при сепсисе [43][44][45] и ВГФС [46][47][48] сходны, при этом во всех работах отмечено ухудшение прогноза у пациентов с гипоальбуминемией. С-реактивный белок и прокальцитонин являются маркерами как воспаления в целом, так и бактериальной инфекции в частности [49,50].…”