The Diagnostic Accuracy Of Procalcitonin for Urinary Tract Infection in Hospitalized Older Adults: a Prospective Study.

TitleThe Diagnostic Accuracy Of Procalcitonin for Urinary Tract Infection in Hospitalized Older Adults: a Prospective Study.
Publication TypeJournal Article
Year of Publication2022
AuthorsChoi JJ, McCarthy MW, Meltzer KK, Cornelius-Schecter A, Jabri A, Reshetnyak E, Banerjee S, Westblade LF, Mehta S, Simon MS, Zhao Z, Glesby MJ
JournalJ Gen Intern Med
Date Published2022 Jan 08
ISSN1525-1497
Abstract

BACKGROUND: The diagnosis of urinary tract infection (UTI) is challenging among hospitalized older adults, particularly among those with altered mental status.

OBJECTIVE: To determine the diagnostic accuracy of procalcitonin (PCT) for UTI in hospitalized older adults.

DESIGN: We performed a prospective cohort study of older adults (≥65 years old) admitted to a single hospital with evidence of pyuria on urinalysis. PCT was tested on initial blood samples. The reference standard was a clinical definition that included the presence of a positive urine culture and any symptom or sign of infection referable to the genitourinary tract. We also surveyed the treating physicians for their clinical judgment and performed expert adjudication of cases for the determination of UTI.

PARTICIPANTS: Two hundred twenty-nine study participants at a major academic medical center.

MAIN MEASURES: We calculated the area under the receiver operating characteristic curve (AUC) of PCT for the diagnosis of UTI.

KEY RESULTS: In this study cohort, 61 (27%) participants met clinical criteria for UTI. The median age of the overall cohort was 82.6 (IQR 74.9-89.7) years. The AUC of PCT for the diagnosis of UTI was 0.56 (95% CI, 0.46-0.65). A series of sensitivity analyses on UTI definition, which included using a decreased threshold for bacteriuria, the treating physicians' clinical judgment, and independent infectious disease specialist adjudication, confirmed the negative result.

CONCLUSIONS: Our findings demonstrate that PCT has limited value in the diagnosis of UTI among hospitalized older adults. Clinicians should be cautious using PCT for the diagnosis of UTI in hospitalized older adults.

DOI10.1007/s11606-021-07265-8
Alternate JournalJ Gen Intern Med
PubMed ID34997392
PubMed Central IDPMC8741546
Grant ListKL2 TR002385 / TR / NCATS NIH HHS / United States
KL2-TR-002385 / TR / NCATS NIH HHS / United States
UL1 TR000457 / TR / NCATS NIH HHS / United States
Investigator-Initiated Study award / / Roche Diagnostics /