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Plasma procalcitonin and urine interleukin-8, Neutrophil Gelatinase-Associated Lipocalin, and calprotectin in the diagnostic process of a urinary tract infection at the emergency department.

OBJECTIVES: To assess the usefulness of plasma procalcitonin and urine interleukin-8 (IL-8), Neutrophil Gelatinase-Associated Lipocalin (NGAL), and calprotectin for diagnosis of urinary tract infections (UTIs) at the emergency department (ED).

METHODS: In adults presenting at the ED with UTI suspicion, biomarker performance was compared to routine diagnostics (urine dipstick, automated urinalysis). Patients with a urine catheter, leukopenia or neither (standard) were analysed separately.

RESULTS: A UTI was clinically diagnosed in 91/196 episodes (46.4%); standard: 29/67 (43.2%), catheter 46/73 (63.0%), leukopenia 17/60 (28.3%) (4 had both). Procalcitonin did not discriminate between UTI and no UTI. Urinary biomarker levels were elevated in UTI episodes (median, µg/mmol creatinine): NGAL 7.8 vs. 46.3, IL-8 6.1 vs. 76.6, calprotectin 23.9 vs. 265.4; the three subgroups also had higher levels. Biomarker cut-off values (90% sensitivity) showed a low specificity (range 20.8%-64.9%) and moderate accuracy (58.6%-75.4%). The biomarkers performed comparable with routine diagnostics, except for leukopenic patients with not-significantly higher AUC values. All urinary biomarkers correlated positively with urine leucocyte count.

CONCLUSIONS: Plasma procalcitonin could not accurately diagnose a UTI. Urine IL-8, NGAL, and calprotectin showed no additional value to routine diagnostics, except a minor improvement in leukopenic patients. These urine biomarkers seem to predominantly reflect leukocyturia.

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