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. 2021 Sep 3;11(9):1168.
doi: 10.3390/brainsci11091168.

Exploring Inflammatory Status in Febrile Seizures Associated with Urinary Tract Infections: A Two-Step Cluster Approach

Raluca Maria Costea  1   2   3 , Ionela Maniu  1   4 , Luminita Dobrota  3 , Rubén Pérez-Elvira  5 , Maria Agudo  5 , Javier Oltra-Cucarella  6 , Andrei Dragomir  7 , Ciprian Bacilă  3 , Adela Banciu  8 , Daniel Dumitru Banciu  8 , Călin Remus Cipăian  3 , Roxana Crișan  3 , Bogdan Neamtu  1   3   9
Affiliations

Exploring Inflammatory Status in Febrile Seizures Associated with Urinary Tract Infections: A Two-Step Cluster Approach

Raluca Maria Costea et al. Brain Sci. .

Abstract

Background: Urinary tract infections (UTIs) are considered common facilitating factors, along with other infections, in triggering febrile seizures (FS). The main purpose of our study was to identify specific inflammatory patterns of UTI cases from other infections in a specific cluster, using a combination of inflammatory biomarkers to differentiate UTIs from other bacterial diseases triggering FS.

Method: This prospective study included a number of 136 patients with 197 distinct FS events, from patients hospitalized in the Pediatric Clinical Hospital Sibiu, among which 10.2% were diagnosed with UTIs.

Results: In one-third of the patients with UTIs (20 cases), the symptoms were limited to fever and FS. Using two-step cluster analysis, a distinct UTI inflammatory pattern has emerged: highest platelet values (PLT), median value 331 × 103/mm3 and intermediate C-reactive protein (CRP), median value 15 mg/dL, platelet distribution width (PDW), median value 9.65%, platelet-large cell ratio (P-LCR), median value 14.45%, mean platelet volume (MPV), median value 8.60 fL and neutrophil-to-lymphocyte values (NLR), median value 3.64. Furthermore, higher PDW (median value 12.25%), P-LCR (median value 28.55%), MPV (median value 10.40 fL), CRP (median value 74.00 mg/dL) and NLR values (median value 4.11) were associated mainly (85.7%) with bacterial lower respiratory infections. UTIs were highly unlikely in these patients with significantly increased CRP values and normal values of platelet indices.

Conclusions: Considering the nonspecific clinical picture of UTIs at an early age, to optimize the management of FS, a fast diagnosis of UTI is mandatory. The analysis of the inflammatory biomarker clusters (rather than individual parameters) correlated with urine leukocyte and nitrite stick evaluation for specific age groups could help in identifying even oligosymptomatic UTIs patients. The study limitation (20 UTI cases) recommends future multicentric trials on larger datasets to validate the model.

Keywords: CRP; cluster analysis; cut-off values; febrile seizures; inflammatory biomarkers; laboratory data; urinary tract infections; urine leukocyte and nitrite stick test.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Pathogenic mechanisms of FS in different infections (viral and bacterial-Gram positive and Gram-negative).
Figure 1
Figure 1
Two step cluster analysis for the whole cohort of patients, using as segmentation variables the proposed inflammatory biomarkers. Clusters 1, 2, 3, and 4 are color-coded and the median values for PDW (%), P-LCR (%), MPV (fL), CRP (mg/dL), and NLR are accordingly presented for each cluster.
See this image and copyright information in PMC

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