• J Gen Intern Med · Nov 2022

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

    • Justin J Choi, Matthew W McCarthy, Kerry K Meltzer, Anna Cornelius-Schecter, Assem Jabri, Evgeniya Reshetnyak, Samprit Banerjee, Lars F Westblade, Saurabh Mehta, Matthew S Simon, Zhen Zhao, and Marshall J Glesby.
    • Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-355, New York, NY, 10021, USA. juc9107@med.cornell.edu.
    • J Gen Intern Med. 2022 Nov 1; 37 (14): 366336693663-3669.

    BackgroundThe diagnosis of urinary tract infection (UTI) is challenging among hospitalized older adults, particularly among those with altered mental status.ObjectiveTo determine the diagnostic accuracy of procalcitonin (PCT) for UTI in hospitalized older adults.DesignWe 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.ParticipantsTwo hundred twenty-nine study participants at a major academic medical center.Main MeasuresWe calculated the area under the receiver operating characteristic curve (AUC) of PCT for the diagnosis of UTI.Key ResultsIn 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.ConclusionsOur 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.© 2021. Society of General Internal Medicine.

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