Use of serum procalcitonin to differentiate acute antepartum
pyelonephritis from asymptomatic bacteriuria and acute cystitis during
pregnancy: A multicentre prospective observational study
Abstract
Objective: To examine whether serum procalcitonin (PCT) is useful for
differentiating acute pyelonephritis (APN) from asymptomatic bacteriuria
and acute cystitis during pregnancy Design: A multicentre prospective
observational study Setting: Eleven maternity hospitals in Taiwan
Population: Two hundred and seventy pregnant women with asymptomatic
bacteriuria, 243 pregnant women with acute cystitis, 186 pregnant women
with APN, and 270 healthy pregnant controls Method: To compare serum
white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR),
C-reactive protein (CRP) level, and PCT level among pregnant women with
asymptomatic bacteriuria, acute cystitis, and APN and healthy pregnant
women (controls) Main outcome measures: Utility of WBC count, ESR, CRP,
and PCT biomarkers for the prediction of APN during pregnancy Results:
Area under the curve (AUC) values of PCT, CRP, ESR, and WBC count for
predicting asymptomatic bacteriuria were 0.576, 0.628, 0.542, and 0.532,
respectively; those for predicting acute cystitis were 0.766, 0.735,
0.681, and 0.597, respectively; and those for predicting acute
pyelonephritis 0.859, 0.763, 0.711, and 0.732, respectively. Compared
with the other inflammatory markers used to predict APN, PCT exhibited
the highest AUC (0.859 [95% confidence interval (CI)
0.711–0.935]). A cutoff value of >0.25 ng/mL had a
sensitivity of 87% and a specificity of 79%. Conclusion: Serum PCT can
be a valuable addition to existing methods of differentiating
asymptomatic bacteriuria, acute cystitis, and APN during pregnancy and
can facilitate the early identification of APN during pregnancy.