ESPN 53rd Annual Meeting

ESPN 2021


 
The Role of Pro-Adrenomedullin in the Diagnosis of Urinary Tract Infection in Children and Comparison with C-Reactive Protein, Procalcitonin, Blood Leukocyte Count
ŞEYMA KÖKSAL ATIŞ 1 ASUMAN KIRAL 1 NILÜFER GÖKNAR 1

1- ISTANBUL MEDENIYET UNIVERSITY GÖZTEPE PROF. DR. SÜLEYMAN YALÇIN CITY HOSPITAL
 
Introduction:

Urinary system infections (UTI) are one of the most common bacterial infections in childhood. UTI should be diagnosed quickly and treatment should be initiated as soon as possible due to its significant morbidity and mortality. In this study, we aimed to investigate the diagnostic value of Pro-adrenomedullin in children with UTI and compare with Procalcitonin, C-Reactive Protein and blood leukocyte count. 

Material and methods:

In this prospective study we enrolled 106 children (62 girls) with a diagnosis of UTI and 31 (21 girls) controls. Urinalysis, complete blood count, Procalcitonin, C-Reactive Protein, BUN, creatinine and, urine culture was done. Venous blood samples for the analysis of Pro-adremonedullin were obtained from all patients before starting antibiotic therapy and one week later.  

Results:

The patients with UTI had higher Pro-Adrenomedullin levels compared to control group (p=0.001). The diagnostic accuracy for predicting the UTI, reflected by the area-under-the-curve of receiver operating characteristics (ROC) were: Pro-adrenomedullin 0,91 (95% CI 0,861-0,971) and, procalcitonin 0,94 (95% CI 0,904-0,989). The ROC analysis showed a cut-off value of 11679 pmol/l for Pro-adrenomedullin. We showed that the risk of UTI was 33,8 times higher in children with Pro-adrenomedullin level above 11679 pmol/l. Based on the cut-off values obtained for Proadrenomedullin and Procalcitonin, we demonstrated that the probability of predicting the diagnosis of UTI was 189.8 times higher when both biomarkers were used. Also, Pro-adrenomedullin levels at initial diagnosis were well correlated with Procalcitonin (r=0,470, p=0.001), CRP (r=0.395, p=0,001) and leukocyte count (r=0,387, p=0.001). Although Procalcitonin, CRP and leukocyte count decreased one week after treatment (p=0,001), there was no statistically significant difference in terms of Pro-adrenomedullin levels (p>0.05). 

 

Conclusions:

Our results demonstrated that Pro-adrenomedullin is a powerful biomarker in the diagnosis of UTI and increases the probability of predicting the diagnosis when used with other biomarkers but not useful for follow-up.