EUROPEAN UROLOGY 66 (2014) 173–178

[8] Rink M, Zabor EC, Furberg H, et al. Impact of smoking and smoking

patients with bladder cancer presenting to a tertiary referral center.

cessation on outcomes in bladder cancer patients treated with radical cystectomy. Eur Urol 2013;64:456–64.

Urology 2012;79:166–71. [15] Strope SA, Montie JE. The causal role of cigarette smoking in bladder

[9] Kobrinsky NL, Klug MG, Hokanson PJ, Sjolander DE, Burd L. Impact

cancer initiation and progression, and the role of urologists in

of smoking on cancer stage at diagnosis. J Clin Oncol 2003;21:

smoking cessation. J Urol 2008;180:31–7, discussion 7.

907–13. [10] Tsivian M, Moreira DM, Caso JR, Mouraviev V, Polascik TJ. Cigarette Michael Rinka,*, Shahrokh F. Shariatb,c,d

smoking is associated with advanced renal cell carcinoma. J Clin a

Oncol 2011;29:2027–31.

Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

[11] Bartoletti R, Cai T, Mondaini N, et al. Prevalence, incidence estimab

Department of Urology, Comprehensive Cancer Center,

tion, risk factors and characterization of chronic prostatitis/chronic

Medical University of Vienna, Vienna, Austria

pelvic pain syndrome in urological hospital outpatients in Italy: results of a multicenter case-control observational study. J Urol 2007;178:2411–5, discussion 5.


Department of Urology, Weill Cornell Medical College, New York, NY, USA


Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

[12] Koskimaki J, Hakama M, Huhtala H, Tammela TL. Association of smoking with lower urinary tract symptoms. J Urol 1998;159: 1580–2. [13] Bassett JC, Gore JL, Chi AC, et al. Impact of a bladder cancer diagnosis

*Corresponding author. University Medical Center Hamburg-Eppendorf, Department of Urology, Martinistr. 52, D-20246 Hamburg, Germany. E-mail address: [email protected] (M. Rink).

on smoking behavior. J Clin Oncol 2012;30:1871–8. [14] Guzzo TJ, Hockenberry MS, Mucksavage P, Bivalacqua TJ, Schoenberg MP. Smoking knowledge assessment and cessation trends in

Re: Procalcitonin as a Diagnostic Marker for Sepsis: A Systematic Review and Meta-analysis Wacker C, Prkno A, Brunkhorst FM, Schlattmann P Lancet Infect Dis 2013;13:426–35 Experts’ summary: The authors evaluated the role of serum procalcitonin (PCT) as a diagnostic marker for sepsis and noninfectious systemic inflammatory response syndromes (SIRS). They performed a meta-analysis including 3244 critically ill patients of whom 1863 (57%) had sepsis and 1381 (43%) SIRS of noninfectious origin. In a subcohort of 1173 sepsis patients, severity of illness (sepsis, severe sepsis, septic shock) was classified. The sites and the sources of infection differed, and most patients were hospitalized in intensive care units. Most studies used a quantitative manual PCT assay, and 73% of the studies met currently available quality standards for PCT determination. The cut-off for PCT concentrations differed between 0.5 ng/ml and 2.0 ng/ml, with a median of 1.1 ng/ml. Pooled sensitivity for testing was 0.77 (95% confidence interval [CI], 0.72–0.81), and pooled specificity was 0.79 (95% CI, 0.74– 0.84). The area under the receiver operating characteristic curve was 0.85 (95% CI, 0.81–0.88). The authors concluded that the analysis pf PCT can differentiate between sepsis and noninfectious SIRS, although due to initial antibiotic therapy, bacteremia occurs in only 30% of patients with sepsis. Unfortunately, although the best cut-off is not really settled due to the absence of a real threshold effect, it is suggested that a value between 1 ng/ml and 2 ng/ml may allow for discrimination between sepsis and other inflammatory diseases.


dysfunction parameters [1]. Unfortunately, besides PCT, other mediators and molecules of the host response to infection, especially C-reactive protein, have been investigated without a breakthrough, as Wacker et al. note. In particular, the prediction of the presence of bacteremia and bacterial load in patients with febrile urinary tract infections (UTIs) would help identify inflammatory status with regard to diagnosing bacteremia as early as possible [2]. Using a PCT level of >0.25 ng/ml as a cut point to predict bacteremia in febrile UTIs [2], the sensitivity and specificity were calculated as 0.95 (95% CI, 0.89–0.98) and 0.50 (95% CI, 0.46–0.55) as criteria to initiate blood cultures in this clinical setting. In this study, the measurement of erythrocyte sedimentation rate and C-reactive protein was not helpful in predicting bacteremia. Considering these results and the data of the presented metaanalysis for sepsis, there is evidence for the significant role of PCT evaluation in a clinical setting to diagnose severely ill, infectious patients with febrile UTIs. Conflicts of interest: The authors have nothing to disclose.

References [1] Wagenlehner FME, et al. Int J Urol 2013;20:963–70. [2] van Nieuwkoop C, et al. Critical Care 2010;14:R206. Wolfgang Weidner*, Florian M.E. Wagenlehner Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Germany *Corresponding author. Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Rudolf-Buchheim-Str. 7, D-35392 Giessen, Germany. E-mail address: [email protected]

Experts’ comments: Urosepsis, defined as sepsis with clear infectious origin, is diagnosed according to clear clinical, laboratory, and organ

(W. Weidner). http://dx.doi.org/10.1016/j.eururo.2014.03.040

Re: Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis.

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