Luo et al used the ratio of serum procalcitonin to albumin to identify a patient with urosepsis. This can help to identify a patient who may benefit from more aggressive management. The authors are from Panyu Central Hospital in Guangzhou, China.
Patient selection: febrile (>= 38°C) urinary tract infection; age >= 18 years of age
Exclusions: pregnancy, history of kidney transplant, dialysis, thyroid disease
Criteria for urinary tract infection:
(1) history of fever or shaking chills within 24 hours of presentation
(2) leukocyturia plus at least one symptom of UTI (flank pain, dysuria)
(3) positive urine culture
Criteria for urosepsis:
(1) positive blood culture for pathogenic bacteria
(2) clinical diagnosis with >= 2 of the following:
(2a) fever > 38°C or hypothermia < 36°C
(2b) tachycardia (> 90 beats per minute)
(2c) tachypnea (> 20 breaths per minute)
(2d) leukocyte count > 12,000 per µL or > 10% immature granulocytes
Parameters:
(1) serum procalcitonin concentration in ng/mL
(2) serum albumin in g/L
ratio of serum procalcitonin to serum albumin =
= (serum procalcitonin) / (serum albumin)
Interpretation:
• A ratio > 0.44 indicates urosepsis.
• The higher the ratio the greater the risk for urosepsis with shock.
Performance:
• The area under the ROC curve was 0.94.
