Prediction of High-Grade Vesicoureteral Reflux after Pediatric Urinary Tract Infection: External Validation Study of Procalcitonin-Based Decision Rule

Background: Predicting vesico-ureteral reflux (VUR) ≥3 at the time of the first urinary tract infection (UTI) would make it possible to restrict cystography to high-risk children. We previously derived the following clinical decision rule for that purpose: cystography should be performed in cases wi...

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Autores: Leroy, Sandrine, Bouissou, François, Fernández López, Anna, Gurgoze, Metin K., Karavanaki, Kyriaki, Ulinski, Tim, Bressan, Silvia, Vaos, Geogios, Leblond, Pierre, Coulais, Yvon, Luaces Cubells, Carles, Aygun, A. Denizmen, Stefanidis, Constantinos J., Bensman, Albert, DaDalt, Liviana, Gardikis, Stefanos, Bigot, Sandra, Gendrel, Dominique, Bréart, Gérard, Chalumeau, Martin
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2011
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/175204
Acceso en línea:https://hdl.handle.net/2445/175204
Access Level:acceso abierto
Palabra clave:Infeccions del tracte urinari
Pediatria
Urinary tract infections
Pediatrics
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spelling Prediction of High-Grade Vesicoureteral Reflux after Pediatric Urinary Tract Infection: External Validation Study of Procalcitonin-Based Decision RuleLeroy, SandrineBouissou, FrançoisFernández López, AnnaGurgoze, Metin K.Karavanaki, KyriakiUlinski, TimBressan, SilviaVaos, GeogiosLeblond, PierreCoulais, YvonLuaces Cubells, CarlesAygun, A. DenizmenStefanidis, Constantinos J.Bensman, AlbertDaDalt, LivianaGardikis, StefanosBigot, SandraGendrel, DominiqueBréart, GérardChalumeau, MartinInfeccions del tracte urinariPediatriaUrinary tract infectionsPediatricsBackground: Predicting vesico-ureteral reflux (VUR) ≥3 at the time of the first urinary tract infection (UTI) would make it possible to restrict cystography to high-risk children. We previously derived the following clinical decision rule for that purpose: cystography should be performed in cases with ureteral dilation and a serum procalcitonin level ≥0.17 ng/mL, or without ureteral dilatation when the serum procalcitonin level ≥0.63 ng/mL. The rule yielded a 86% sensitivity with a 46% specificity. We aimed to test its reproducibility. Study design: A secondary analysis of prospective series of children with a first UTI. The rule was applied, and predictive ability was calculated. Results: The study included 413 patients (157 boys, VUR ≥3 in 11%) from eight centers in five countries. The rule offered a 46% specificity (95% CI, 41-52), not different from the one in the derivation study. However, the sensitivity significantly decreased to 64% (95%CI, 50-76), leading to a difference of 20% (95%CI, 17-36). In all, 16 (34%) patients among the 47 with VUR ≥3 were misdiagnosed by the rule. This lack of reproducibility might result primarily from a difference between derivation and validation populations regarding inflammatory parameters (CRP, PCT); the validation set samples may have been collected earlier than for the derivation one. Conclusions: The rule built to predict VUR ≥3 had a stable specificity (ie. 46%), but a decreased sensitivity (ie. 64%) because of the time variability of PCT measurement. Some refinement may be warranted.Public Library of Science (PLoS)2011info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/175204Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1371/journal.pone.0029556PLoS One, 2011, vol. 6, num. 12, p. e29556https://doi.org/10.1371/journal.pone.0029556cc-by (c) Leroy, Sandrine et al., 2011http://creativecommons.org/licenses/by/3.0/esinfo:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1752042026-05-27T06:46:51Z
dc.title.none.fl_str_mv Prediction of High-Grade Vesicoureteral Reflux after Pediatric Urinary Tract Infection: External Validation Study of Procalcitonin-Based Decision Rule
title Prediction of High-Grade Vesicoureteral Reflux after Pediatric Urinary Tract Infection: External Validation Study of Procalcitonin-Based Decision Rule
spellingShingle Prediction of High-Grade Vesicoureteral Reflux after Pediatric Urinary Tract Infection: External Validation Study of Procalcitonin-Based Decision Rule
Leroy, Sandrine
Infeccions del tracte urinari
Pediatria
Urinary tract infections
Pediatrics
title_short Prediction of High-Grade Vesicoureteral Reflux after Pediatric Urinary Tract Infection: External Validation Study of Procalcitonin-Based Decision Rule
title_full Prediction of High-Grade Vesicoureteral Reflux after Pediatric Urinary Tract Infection: External Validation Study of Procalcitonin-Based Decision Rule
title_fullStr Prediction of High-Grade Vesicoureteral Reflux after Pediatric Urinary Tract Infection: External Validation Study of Procalcitonin-Based Decision Rule
title_full_unstemmed Prediction of High-Grade Vesicoureteral Reflux after Pediatric Urinary Tract Infection: External Validation Study of Procalcitonin-Based Decision Rule
title_sort Prediction of High-Grade Vesicoureteral Reflux after Pediatric Urinary Tract Infection: External Validation Study of Procalcitonin-Based Decision Rule
dc.creator.none.fl_str_mv Leroy, Sandrine
Bouissou, François
Fernández López, Anna
Gurgoze, Metin K.
Karavanaki, Kyriaki
Ulinski, Tim
Bressan, Silvia
Vaos, Geogios
Leblond, Pierre
Coulais, Yvon
Luaces Cubells, Carles
Aygun, A. Denizmen
Stefanidis, Constantinos J.
Bensman, Albert
DaDalt, Liviana
Gardikis, Stefanos
Bigot, Sandra
Gendrel, Dominique
Bréart, Gérard
Chalumeau, Martin
author Leroy, Sandrine
author_facet Leroy, Sandrine
Bouissou, François
Fernández López, Anna
Gurgoze, Metin K.
Karavanaki, Kyriaki
Ulinski, Tim
Bressan, Silvia
Vaos, Geogios
Leblond, Pierre
Coulais, Yvon
Luaces Cubells, Carles
Aygun, A. Denizmen
Stefanidis, Constantinos J.
Bensman, Albert
DaDalt, Liviana
Gardikis, Stefanos
Bigot, Sandra
Gendrel, Dominique
Bréart, Gérard
Chalumeau, Martin
author_role author
author2 Bouissou, François
Fernández López, Anna
Gurgoze, Metin K.
Karavanaki, Kyriaki
Ulinski, Tim
Bressan, Silvia
Vaos, Geogios
Leblond, Pierre
Coulais, Yvon
Luaces Cubells, Carles
Aygun, A. Denizmen
Stefanidis, Constantinos J.
Bensman, Albert
DaDalt, Liviana
Gardikis, Stefanos
Bigot, Sandra
Gendrel, Dominique
Bréart, Gérard
Chalumeau, Martin
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Infeccions del tracte urinari
Pediatria
Urinary tract infections
Pediatrics
topic Infeccions del tracte urinari
Pediatria
Urinary tract infections
Pediatrics
description Background: Predicting vesico-ureteral reflux (VUR) ≥3 at the time of the first urinary tract infection (UTI) would make it possible to restrict cystography to high-risk children. We previously derived the following clinical decision rule for that purpose: cystography should be performed in cases with ureteral dilation and a serum procalcitonin level ≥0.17 ng/mL, or without ureteral dilatation when the serum procalcitonin level ≥0.63 ng/mL. The rule yielded a 86% sensitivity with a 46% specificity. We aimed to test its reproducibility. Study design: A secondary analysis of prospective series of children with a first UTI. The rule was applied, and predictive ability was calculated. Results: The study included 413 patients (157 boys, VUR ≥3 in 11%) from eight centers in five countries. The rule offered a 46% specificity (95% CI, 41-52), not different from the one in the derivation study. However, the sensitivity significantly decreased to 64% (95%CI, 50-76), leading to a difference of 20% (95%CI, 17-36). In all, 16 (34%) patients among the 47 with VUR ≥3 were misdiagnosed by the rule. This lack of reproducibility might result primarily from a difference between derivation and validation populations regarding inflammatory parameters (CRP, PCT); the validation set samples may have been collected earlier than for the derivation one. Conclusions: The rule built to predict VUR ≥3 had a stable specificity (ie. 46%), but a decreased sensitivity (ie. 64%) because of the time variability of PCT measurement. Some refinement may be warranted.
publishDate 2011
dc.date.none.fl_str_mv 2011
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/175204
url https://hdl.handle.net/2445/175204
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1371/journal.pone.0029556
PLoS One, 2011, vol. 6, num. 12, p. e29556
https://doi.org/10.1371/journal.pone.0029556
dc.rights.none.fl_str_mv cc-by (c) Leroy, Sandrine et al., 2011
http://creativecommons.org/licenses/by/3.0/es
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Leroy, Sandrine et al., 2011
http://creativecommons.org/licenses/by/3.0/es
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Public Library of Science (PLoS)
publisher.none.fl_str_mv Public Library of Science (PLoS)
dc.source.none.fl_str_mv Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,301629

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