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Concomitant emphysema might increase the false-negative rate of urinary antigen tests in patients with pneumococcal pneumonia: results from a retrospective study

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Abstract

The urinary antigen test (UAT) is a rapid diagnostic method for pneumococcal pneumonia, but the high false-negative rate of 30% may affect its reliability. To maximize the utility of UAT, it is necessary to investigate the patient factors affecting UAT results. However, there is no report elucidating the association between its utility and pre-existing lung abnormalities. We retrospectively reviewed 388 patients with pneumococcal pneumonia confirmed by blood and/or sputum culture tests. Finally, 94 of 388 patients who had the results of UAT and computed tomography scans were enrolled to evaluate the association between the utility of UAT and patient factors including pulmonary emphysema and fibrosis. The overall positive rate of UAT was 69.1%. The positive rates of UAT in the patients with emphysema were significantly lower than those in individuals without emphysema (33.3% and 77.6%, p < 0.001). Univariate logistic regression analysis showed that the presence of emphysema was associated with a low positive rate (odds ratio 6.944, 95% confidence interval 2.268–21.231). Multivariate logistic analysis showed that the presence of emphysema and lower levels of serum blood urea nitrogen (BUN) were significantly and independently associated with a low positive rate. The combination of emphysema and BUN can potentially stratify the positive rate of UAT in patients with pneumococcal pneumonia. Patients with pneumococcal pneumonia and emphysema have a lower positive rate of UAT. Additionally, the combination of emphysema and serum BUN value may be useful to evaluate the reliability of the negative results of pneumococcal UAT.

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The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Erika Kobayashi, Kakuhiro Yamaguchi, Shinjiro Sakamoto, Yasushi Horimasu, Takeshi Masuda, Shintaro Miyamoto, Taku Nakashima, Hiroshi Iwamoto, Kazunori Fujitaka & Noboru Hattori

  2. Division of Clinical Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan

    Rie Nagaoka & Michiya Yokozaki

  3. Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan

    Hiroki Ohge

  4. Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Hironobu Hamada

Authors
  1. Erika Kobayashi
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  2. Kakuhiro Yamaguchi
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  3. Rie Nagaoka
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  4. Shinjiro Sakamoto
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  5. Yasushi Horimasu
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  6. Takeshi Masuda
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  7. Shintaro Miyamoto
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  8. Taku Nakashima
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  9. Hiroshi Iwamoto
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  10. Kazunori Fujitaka
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  11. Michiya Yokozaki
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  12. Hiroki Ohge
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  13. Hironobu Hamada
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  14. Noboru Hattori
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Contributions

All authors contributed to the study conception, material preparation, and data collection. Statistical analysis was performed by Erika Kobayashi and Kakuhiro Yamaguchi, and the first draft of the manuscript was written by Erika Kobayashi and Kakuhiro Yamaguchi. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kakuhiro Yamaguchi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of Hiroshima University Hospital (No. E1837).

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To obtain consent of the patients, the opt-out method was used.

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To obtain consent of the patients, the opt-out method was used.

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Kobayashi, E., Yamaguchi, K., Nagaoka, R. et al. Concomitant emphysema might increase the false-negative rate of urinary antigen tests in patients with pneumococcal pneumonia: results from a retrospective study. Eur J Clin Microbiol Infect Dis 40, 871–877 (2021). https://doi.org/10.1007/s10096-020-04095-0

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  • DOI: https://doi.org/10.1007/s10096-020-04095-0

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