Journal of Endourology
Page 1 of 17
© Mary Ann Liebert, Inc. DOI: 10.1089/end.2020.0308
1
The Use of Serum Procalcitonin in the Setting of Infected Ureteral
Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
Stones: A Prospective Observational Study Edward Capoccia M.D., Patrick Whelan, M.D., Benjamin Sherer, Pete Tsambarlis, M.D., Wei Phin Tan, M.D., Alexander Chow, M.D., Michael Ryan Farrell, M.D., Brijesh Patel, M.D., Shaan Setia, M.D., Brittany M. Wilson, PhD1, Yanyu Zhang, MS2, Dimitri Papagiannopoulos M.D. Department of Urology, 1Department of Cell & Molecular Medicine, 2Department of Bioinformatics and Biostatistics Rush University Medical Center, Chicago, IL Abstract Word Count: 254 Manuscript Word Count: 2913 Tables (#): 4 Key Words: Urinary tract infections, Procalcitonin, Obstructing urolithiasis, infected stones Corresponding Author: Edward Capoccia, M.D. Phone: 913-961-4468 [email protected]
Page 2 of 17
2 Introduction: Infected ureteral stones are a urologic emergency and require urgent Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
decompression. We set out to determine if serum procalcitonin could aid in the diagnosis of infected ureteral stones. Methods: All consecutive patients presenting to the emergency room from 11/9/2016 to 11/10/2018 with an obstructing ureteral stone were included. All patients had complete blood count (CBC), urinalysis (UA), procalcitonin (PCT) and urine culture (UCx). Subgroup analysis was performed in a "clinically equivocal" cohort of afebrile patients defined as a leukocytosis >10^4/l and UA with 0.5 ng/ml has a high PPV to rule in sepsis while a value 100.4F or 90 beats/minute, respiratory rate >20 breaths/minute, and WBC >12^4/l.15 The median PCT value in this group was 0.079 ng/ml. A total of seven patients required ICU care after urinary tract decompression for hemodynamic monitoring due to labile vital signs. All of these patients recovered without issue with resuscitation and antibiotics. The univariate analysis results and the multivariable logistic regression model for the entire cohort can be seen in tables 2 and 3, respectively. Of all the covariates, UA WBC with a cutoff of 9 per hpf had the highest AUC. All covariates showed a statistically significant difference when comparing those with and without a positive UCx. While adjusting for other covariates, patients with UA WBC >9 per hpf are more likely to have positive UCx than patients with UA WBC 0.08 ng/ml are also more likely to have a positive UCx than patients with PCT 6 per hpf and WBC differential >86%. While adjusting for other covariates, patients with WBC differential >86% are more likely to have a positive UCx than patients with WBC differential 6 per hpf are more likely to have positive UCx than those with UA WBC 9 per hpf at our institution is the strongest predictor for infection when controlling for other variables. When looking specifically at the clinically equivocal group, UA WBC >6 per hpf, and WBC differential >86.37% met statistical significance in predicting a positive urine culture with OR of 6.8 and 12.5 respectively. Based on these results, PCT is predictive in diagnosing an infected ureteral stone when looking at all patients presenting to the ED with a ureteral stone, however it does not appear to be superior to the standard workup of UA WBC and WBC differential. The biomarkers PCT, CRP, and ESR do not outperform the components of the standard workup when evaluating stone patients for concomitant infections. Based on these results, PCT, CRP, and ESR may have limited utility in this patient population. However, this brings to question whether there is utility for further study into a serum biomarker in the diagnosis of UTI in the setting of an obstructing ureteral stone. Our study would suggest so, as only a third of patients with positive urine cultures had signs of fevers (32%) and findings of nitrite positive (30%) and LE positive (38%) on UA. Thus, a strong biomarker to aid in diagnosing infected ureteral stones is needed and demands further investigation. There are several notable limitations to this study. This was an observational study with data collected from chart review with inherent limitations when relying on the accuracy of the electronic medical record. Another limitation is our sample size. Although we exceeded our goal of 30 patients with positive UCx to compare with 30 controls with negative UCx, we only had 17 patients in the clinically equivocal cohort with a positive UCx. This low sample size decreases the statistical power of our subgroup analysis. We defined our clinically equivocal cohort as having no fever, a UA WBC 10^4/l. This definition was determined by the investigators based on their clinical experience. There are going to be patients in this study that did not meet these criteria, however still had signs and symptoms equivocal for infection and thus pose a diagnostic dilemma. Another limitation is that PCT values can be elevated in certain non-infectious conditions such as surgery, cardiogenic shock, autoimmune disorders, and severe renal or liver dysfunction, and these conditions were not controlled for in this study.6 Despite
Page 10 of 17
10 these limitations, this is a novel, prospective study with real-world pertinence to the Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
practicing urologist. Conclusion PCT does not appear to be a superior marker for diagnosing UTI in the setting of an obstructing ureteral stone when compared to components of the standard workup. UA WBC performed the best in both the overall and clinically equivocal cohorts. The entire clinical picture should be considered when determining the need for urgent upper tract decompression. None of the biomarkers evaluated, including PCT, CRP, and ESR performed well enough to be routinely used in this patient population. Until better biomarkers are discovered, clinical intuition based on patient factors and the standard laboratory workup will continue to be used to determine which patients require urgent decompression. Given the potential serious consequences of missing this diagnosis, continued efforts are needed to evaluate clinically useful biomarkers.
Page 11 of 17
11
Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
References 1.
Sugimoto K, Adomi S, Koike H, Esa A. Procalcitonin as an indicator of urosepsis. Res Rep Urol. 2013;5:77-80.
2.
Tschaikowsky K, Hedwig-geissing M, Braun GG, Radespiel-troeger M. Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis. J Crit Care. 2011;26(1):54-64.
3.
Kinasewitz GT, Yan SB, Basson B, et al. Universal changes in biomarkers of coagulation and inflammation occur in patients with severe sepsis, regardless of causative micro-organism [ISRCTN74215569]. Crit Care. 2004;8(2):R82-90.
4.
Franz M, Hörl WH. Common errors in diagnosis and management of urinary tract infection. I: pathophysiology and diagnostic techniques. Nephrol Dial Transplant. 1999;14(11):2746-53.
5.
Ko YH, Ji YS, Park SY, Kim SJ, Song PH. Procalcitonin determined at emergency department as an early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi. Int Braz J Urol. 2016;42(2):270-6.
6.
Meisner M. Update on procalcitonin measurements. Ann Lab Med. 2014;34(4):263-73.
7.
Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341(8844):515-8.
8.
Van nieuwkoop C, Bonten TN, Van't wout JW, et al. Procalcitonin reflects bacteremia and bacterial load in urosepsis syndrome: a prospective observational study. Crit Care. 2010;14(6):R206.
9.
Suprin E, Camus C, Gacouin A, et al. Procalcitonin: a valuable indicator of infection in a medical ICU?. Intensive Care Med. 2000;26(9):1232-8.
10.
Masajtis-zagajewska A, Nowicki M. New markers of urinary tract infection. Clin Chim Acta. 2017;471:286-291.
11.
Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab. 1994;79(6):1605-8.
Page 12 of 17
12.
12 Limper M, De kruif MD, Duits AJ, Brandjes DP, Van gorp EC. The diagnostic role
Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
of procalcitonin and other biomarkers in discriminating infectious from noninfectious fever. J Infect. 2010;60(6):409-16. 13.
Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster- randomised, single-blinded intervention trial. Lancet 2004;363:600-7.
14.
Chirouze C, Schuhmacher H, Rabaud C, et al. Low serum procalcitonin level accurately predicts the absence of bacteremia in adult patients with acute fever. Clin Infect Dis. 2002;35(2):156-61.
15.
Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296-327.
16.
Blackwell RH, Barton GJ, Kothari AN, et al. Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice. J Urol. 2016;196(1):124-30.
17.
Papagiannopoulos D, Whelan P, Ahmad W, et al. Procalcitonin is a strong predictor of urine culture results in patients with obstructing ureteral stones: A prospective, pilot study. Urol Ann. 2016;8(3):277-80.
18.
Yu Y, Li XX, Jiang LX, et al. Procalcitonin levels in patients with positive blood culture, positive body fluid culture, sepsis, and severe sepsis: a cross-sectional study. Infect Dis (Lond). 2016;48(1):63-9.
Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
Page 13 of 17
13
Abbreviations
CBC – complete blood count
UA – urinalysis
UTI – urinary tract infection
PCT – procalcitonin
UCx – urine culture
WBC – white blood count
CRP – C-reactive protein
Hpf – high powered field
AUC – area under the curve
PPV – positive predictive value
NPV – negative predictive value
ER – emergency room
Page 14 of 17
14
Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
Table 1 - Descriptive for covariates
Variable Levels Total Preop Fever, N(%) Fever 22 (9.61) No Fever 207 (90.39) Nitrite, N(%) Positive 22 (9.52) Negative 209 (90.48) LE, N(%) Positive 25 (10.82) Moderate 15 (6.49) Negative 191 (82.68) UA WBC, Mean (SD) 26.03 (55.5) WBC, Mean (SD) 11.17 (4) Diff, Mean (SD) 73.4 (14.13) ESR, Mean (SD) 19.24 (22.29) CRP, Mean (SD) 25.04 (64.17) PCT, Mean (SD) 5.12 (6.5)
Positive Ucx 56 (24.24%) 18 (32.14) 38 (67.86) 17 (30.36) 39 (69.64) 21 (37.5) 8 (14.29) 27 (48.21) 88.64 (84.43) 12.93 (5.03) 80.76 (11.99) 30.71 (32.86) 74.65 (113.57) 20.87 (98.42)
Negative Ucx 175 (75.76%) 4 (2.31) 169 (97.69) 5 (2.86) 170 (97.14) 4 (2.29) 7 (4) 164 (93.71) 5.77 (10.72) 10.61 (3.45) 71.04 (13.97) 15.58 (16.12) 9.18 (18.03) 0.08 (0.41)
P-Value
Page 1 of 17
© Mary Ann Liebert, Inc. DOI: 10.1089/end.2020.0308
1
The Use of Serum Procalcitonin in the Setting of Infected Ureteral
Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
Stones: A Prospective Observational Study Edward Capoccia M.D., Patrick Whelan, M.D., Benjamin Sherer, Pete Tsambarlis, M.D., Wei Phin Tan, M.D., Alexander Chow, M.D., Michael Ryan Farrell, M.D., Brijesh Patel, M.D., Shaan Setia, M.D., Brittany M. Wilson, PhD1, Yanyu Zhang, MS2, Dimitri Papagiannopoulos M.D. Department of Urology, 1Department of Cell & Molecular Medicine, 2Department of Bioinformatics and Biostatistics Rush University Medical Center, Chicago, IL Abstract Word Count: 254 Manuscript Word Count: 2913 Tables (#): 4 Key Words: Urinary tract infections, Procalcitonin, Obstructing urolithiasis, infected stones Corresponding Author: Edward Capoccia, M.D. Phone: 913-961-4468 [email protected]
Page 2 of 17
2 Introduction: Infected ureteral stones are a urologic emergency and require urgent Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
decompression. We set out to determine if serum procalcitonin could aid in the diagnosis of infected ureteral stones. Methods: All consecutive patients presenting to the emergency room from 11/9/2016 to 11/10/2018 with an obstructing ureteral stone were included. All patients had complete blood count (CBC), urinalysis (UA), procalcitonin (PCT) and urine culture (UCx). Subgroup analysis was performed in a "clinically equivocal" cohort of afebrile patients defined as a leukocytosis >10^4/l and UA with 0.5 ng/ml has a high PPV to rule in sepsis while a value 100.4F or 90 beats/minute, respiratory rate >20 breaths/minute, and WBC >12^4/l.15 The median PCT value in this group was 0.079 ng/ml. A total of seven patients required ICU care after urinary tract decompression for hemodynamic monitoring due to labile vital signs. All of these patients recovered without issue with resuscitation and antibiotics. The univariate analysis results and the multivariable logistic regression model for the entire cohort can be seen in tables 2 and 3, respectively. Of all the covariates, UA WBC with a cutoff of 9 per hpf had the highest AUC. All covariates showed a statistically significant difference when comparing those with and without a positive UCx. While adjusting for other covariates, patients with UA WBC >9 per hpf are more likely to have positive UCx than patients with UA WBC 0.08 ng/ml are also more likely to have a positive UCx than patients with PCT 6 per hpf and WBC differential >86%. While adjusting for other covariates, patients with WBC differential >86% are more likely to have a positive UCx than patients with WBC differential 6 per hpf are more likely to have positive UCx than those with UA WBC 9 per hpf at our institution is the strongest predictor for infection when controlling for other variables. When looking specifically at the clinically equivocal group, UA WBC >6 per hpf, and WBC differential >86.37% met statistical significance in predicting a positive urine culture with OR of 6.8 and 12.5 respectively. Based on these results, PCT is predictive in diagnosing an infected ureteral stone when looking at all patients presenting to the ED with a ureteral stone, however it does not appear to be superior to the standard workup of UA WBC and WBC differential. The biomarkers PCT, CRP, and ESR do not outperform the components of the standard workup when evaluating stone patients for concomitant infections. Based on these results, PCT, CRP, and ESR may have limited utility in this patient population. However, this brings to question whether there is utility for further study into a serum biomarker in the diagnosis of UTI in the setting of an obstructing ureteral stone. Our study would suggest so, as only a third of patients with positive urine cultures had signs of fevers (32%) and findings of nitrite positive (30%) and LE positive (38%) on UA. Thus, a strong biomarker to aid in diagnosing infected ureteral stones is needed and demands further investigation. There are several notable limitations to this study. This was an observational study with data collected from chart review with inherent limitations when relying on the accuracy of the electronic medical record. Another limitation is our sample size. Although we exceeded our goal of 30 patients with positive UCx to compare with 30 controls with negative UCx, we only had 17 patients in the clinically equivocal cohort with a positive UCx. This low sample size decreases the statistical power of our subgroup analysis. We defined our clinically equivocal cohort as having no fever, a UA WBC 10^4/l. This definition was determined by the investigators based on their clinical experience. There are going to be patients in this study that did not meet these criteria, however still had signs and symptoms equivocal for infection and thus pose a diagnostic dilemma. Another limitation is that PCT values can be elevated in certain non-infectious conditions such as surgery, cardiogenic shock, autoimmune disorders, and severe renal or liver dysfunction, and these conditions were not controlled for in this study.6 Despite
Page 10 of 17
10 these limitations, this is a novel, prospective study with real-world pertinence to the Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
practicing urologist. Conclusion PCT does not appear to be a superior marker for diagnosing UTI in the setting of an obstructing ureteral stone when compared to components of the standard workup. UA WBC performed the best in both the overall and clinically equivocal cohorts. The entire clinical picture should be considered when determining the need for urgent upper tract decompression. None of the biomarkers evaluated, including PCT, CRP, and ESR performed well enough to be routinely used in this patient population. Until better biomarkers are discovered, clinical intuition based on patient factors and the standard laboratory workup will continue to be used to determine which patients require urgent decompression. Given the potential serious consequences of missing this diagnosis, continued efforts are needed to evaluate clinically useful biomarkers.
Page 11 of 17
11
Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
References 1.
Sugimoto K, Adomi S, Koike H, Esa A. Procalcitonin as an indicator of urosepsis. Res Rep Urol. 2013;5:77-80.
2.
Tschaikowsky K, Hedwig-geissing M, Braun GG, Radespiel-troeger M. Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis. J Crit Care. 2011;26(1):54-64.
3.
Kinasewitz GT, Yan SB, Basson B, et al. Universal changes in biomarkers of coagulation and inflammation occur in patients with severe sepsis, regardless of causative micro-organism [ISRCTN74215569]. Crit Care. 2004;8(2):R82-90.
4.
Franz M, Hörl WH. Common errors in diagnosis and management of urinary tract infection. I: pathophysiology and diagnostic techniques. Nephrol Dial Transplant. 1999;14(11):2746-53.
5.
Ko YH, Ji YS, Park SY, Kim SJ, Song PH. Procalcitonin determined at emergency department as an early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi. Int Braz J Urol. 2016;42(2):270-6.
6.
Meisner M. Update on procalcitonin measurements. Ann Lab Med. 2014;34(4):263-73.
7.
Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341(8844):515-8.
8.
Van nieuwkoop C, Bonten TN, Van't wout JW, et al. Procalcitonin reflects bacteremia and bacterial load in urosepsis syndrome: a prospective observational study. Crit Care. 2010;14(6):R206.
9.
Suprin E, Camus C, Gacouin A, et al. Procalcitonin: a valuable indicator of infection in a medical ICU?. Intensive Care Med. 2000;26(9):1232-8.
10.
Masajtis-zagajewska A, Nowicki M. New markers of urinary tract infection. Clin Chim Acta. 2017;471:286-291.
11.
Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab. 1994;79(6):1605-8.
Page 12 of 17
12.
12 Limper M, De kruif MD, Duits AJ, Brandjes DP, Van gorp EC. The diagnostic role
Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
of procalcitonin and other biomarkers in discriminating infectious from noninfectious fever. J Infect. 2010;60(6):409-16. 13.
Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster- randomised, single-blinded intervention trial. Lancet 2004;363:600-7.
14.
Chirouze C, Schuhmacher H, Rabaud C, et al. Low serum procalcitonin level accurately predicts the absence of bacteremia in adult patients with acute fever. Clin Infect Dis. 2002;35(2):156-61.
15.
Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296-327.
16.
Blackwell RH, Barton GJ, Kothari AN, et al. Early Intervention during Acute Stone Admissions: Revealing "The Weekend Effect" in Urological Practice. J Urol. 2016;196(1):124-30.
17.
Papagiannopoulos D, Whelan P, Ahmad W, et al. Procalcitonin is a strong predictor of urine culture results in patients with obstructing ureteral stones: A prospective, pilot study. Urol Ann. 2016;8(3):277-80.
18.
Yu Y, Li XX, Jiang LX, et al. Procalcitonin levels in patients with positive blood culture, positive body fluid culture, sepsis, and severe sepsis: a cross-sectional study. Infect Dis (Lond). 2016;48(1):63-9.
Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
Page 13 of 17
13
Abbreviations
CBC – complete blood count
UA – urinalysis
UTI – urinary tract infection
PCT – procalcitonin
UCx – urine culture
WBC – white blood count
CRP – C-reactive protein
Hpf – high powered field
AUC – area under the curve
PPV – positive predictive value
NPV – negative predictive value
ER – emergency room
Page 14 of 17
14
Journal of Endourology The Use of Serum Procalcitonin in the Setting of Infected Ureteral Stones: A Prospective Observational Study (DOI: 10.1089/end.2020.0308) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
Downloaded by SUNY Stony Brook package(NERL) from www.liebertpub.com at 10/04/20. For personal use only.
Table 1 - Descriptive for covariates
Variable Levels Total Preop Fever, N(%) Fever 22 (9.61) No Fever 207 (90.39) Nitrite, N(%) Positive 22 (9.52) Negative 209 (90.48) LE, N(%) Positive 25 (10.82) Moderate 15 (6.49) Negative 191 (82.68) UA WBC, Mean (SD) 26.03 (55.5) WBC, Mean (SD) 11.17 (4) Diff, Mean (SD) 73.4 (14.13) ESR, Mean (SD) 19.24 (22.29) CRP, Mean (SD) 25.04 (64.17) PCT, Mean (SD) 5.12 (6.5)
Positive Ucx 56 (24.24%) 18 (32.14) 38 (67.86) 17 (30.36) 39 (69.64) 21 (37.5) 8 (14.29) 27 (48.21) 88.64 (84.43) 12.93 (5.03) 80.76 (11.99) 30.71 (32.86) 74.65 (113.57) 20.87 (98.42)
Negative Ucx 175 (75.76%) 4 (2.31) 169 (97.69) 5 (2.86) 170 (97.14) 4 (2.29) 7 (4) 164 (93.71) 5.77 (10.72) 10.61 (3.45) 71.04 (13.97) 15.58 (16.12) 9.18 (18.03) 0.08 (0.41)
P-Value
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