• Virginie Lemiale, Bertrand Renaud, Stéphane Moutereau, Alfred N'Gako, Mirna Salloum, Marie Jeanne Calmettes, Jérôme Hervé, Cyril Boraud, Aline Santin, Jean-Claude Grégo, François Braconnier, and Eric Roupie.
• Emergency Department of Henri Mondor Hospital (AP-HP), 51 avenue du Maréchal Delattre de Tassigny, 94010 Créteil Cedex, France.
• Eur. Urol. 2007 May 1;51(5):1394-401.

ObjectivesPredicting medical outcomes for pyelonephritis in women is difficult, leading to unnecessary hospitalization. Unlike other serious infectious diseases, high procalcitonin (PCT) level has never been associated with 28-d adverse medical outcomes in women with pyelonephritis. Therefore, we sought to determine the accuracy of PCT in discriminating between pyelonephritis with adverse medical outcome (PAMO) and pyelonephritis without adverse medical outcome (PWAMO).Patients And MethodsAdult women with pyelonephritis presenting to the emergency department of a French tertiary care hospital were consecutively included. Those patients who developed adverse medical outcomes during a 28-d follow-up period were identified as having PAMO. Baseline characteristics and PCT level were compared between patients with PAMO and PWAMO.ResultsEleven women (19.0%) had PAMO and 47 (81%) had PWAMO. The median PCT level was higher in PAMO compared with PWAMO 0.51 ng/ml (IQR: 0.04-3.8) and 0.08 ng/ml (IQR: 0.01-1.0), but this difference was not statistically significant (p=0.07). We failed to find a threshold value for PCT that discriminated between PAMO and PWAMO (ROC, AUC=0.67 [95%CI, 0.51-0.86]). All but one subject with PAMO had either a PCT level >0.1 ng/ml or an underlying genitourinary abnormality by radiographic testing.ConclusionsA single PCT level was a poor predictor of 28-d adverse medical outcomes in women with pyelonephritis treated in the emergency department. Prediction based on underlying genitourinary abnormality by radiographic testing in addition to the PCT level should be investigated in future studies.

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