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Multicenter Study
. 2011;6(12):e29556.
doi: 10.1371/journal.pone.0029556. Epub 2011 Dec 28.

Prediction of high-grade vesicoureteral reflux after pediatric urinary tract infection: external validation study of procalcitonin-based decision rule

Sandrine Leroy  1 , François Bouissou, Anna Fernandez-Lopez, Metin K Gurgoze, Kyriaki Karavanaki, Tim Ulinski, Silvia Bressan, Geogios Vaos, Pierre Leblond, Yvon Coulais, Carlos Luaces Cubells, A Denizmen Aygun, Constantinos J Stefanidis, Albert Bensman, Liviana Da Dalt, Stefanos Gardikis, Sandra Bigot, Dominique Gendrel, Gérard Bréart, Martin Chalumeau
Affiliations
Multicenter Study

Prediction of high-grade vesicoureteral reflux after pediatric urinary tract infection: external validation study of procalcitonin-based decision rule

Sandrine Leroy et al. PLoS One. 2011.

Erratum in

  • PLoS One. 2012 Feb 21;78(8). doi: 10.1371/annotation/c23484a1-f516-4391-a23b-3db456be8edf

Abstract

Background: Predicting vesico-ureteral reflux (VUR) ≥3 at the time of the first urinary tract infection (UTI) would make it possible to restrict cystography to high-risk children. We previously derived the following clinical decision rule for that purpose: cystography should be performed in cases with ureteral dilation and a serum procalcitonin level ≥0.17 ng/mL, or without ureteral dilatation when the serum procalcitonin level ≥0.63 ng/mL. The rule yielded a 86% sensitivity with a 46% specificity. We aimed to test its reproducibility.

Study design: A secondary analysis of prospective series of children with a first UTI. The rule was applied, and predictive ability was calculated.

Results: The study included 413 patients (157 boys, VUR ≥3 in 11%) from eight centers in five countries. The rule offered a 46% specificity (95% CI, 41-52), not different from the one in the derivation study. However, the sensitivity significantly decreased to 64% (95%CI, 50-76), leading to a difference of 20% (95%CI, 17-36). In all, 16 (34%) patients among the 47 with VUR ≥3 were misdiagnosed by the rule. This lack of reproducibility might result primarily from a difference between derivation and validation populations regarding inflammatory parameters (CRP, PCT); the validation set samples may have been collected earlier than for the derivation one.

Conclusions: The rule built to predict VUR ≥3 had a stable specificity (ie. 46%), but a decreased sensitivity (ie. 64%) because of the time variability of PCT measurement. Some refinement may be warranted.

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Conflict of interest statement

Competing Interests: Professors Gendrel and Chalumeau have received unrestricted educational grants for other studies, for a total amount lower than €5000, from Brahms AG, the manufacturer of procalcitonin, in 2007. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Diagnosis tree and distribution of the study population at each step of the decision rule in the validation population.
Abbreviations: PCT, Procalcitonin; VUR, Vesico-ureteral reflux.
Figure 2
Figure 2. Distribution of Procalcitonin values according to the presence of high-grade VUR and the presence of Ureteral dilation on renal ultrasonography.
Figure 3
Figure 3. Distribution of Procalcitonin values according to the presence of high-grade VUR and the presence of Ureteral dilation on renal ultrasonography.
The horizontal lines are the dichotomization threshold in each group.
See this image and copyright information in PMC

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