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Published in: BMC Primary Care 1/2021

Open Access 01-12-2021 | Pyelonephritis | Research

Diagnostic value of biomarkers for paediatric urinary tract infections in primary care: systematic review and meta-analysis

Authors: Hanne A. Boon, Thomas Struyf, Dominique Bullens, Ann Van den Bruel, Jan Y. Verbakel

Published in: BMC Primary Care | Issue 1/2021

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Abstract

Background

Accurate diagnosis of urinary tract infection is essential as children left untreated may suffer permanent renal injury.

Aim

To compare the diagnostic values of biomarkers or clinical prediction rules for urinary tract infections in children presenting to ambulatory care.

Design and setting

Systematic review and meta-analysis of ambulatory care studies.

Methods

Medline, Embase, WOS, CINAHL, Cochrane library, HTA and DARE were searched until 21 May 2021. We included diagnostic studies on urine or blood biomarkers for cystitis or pyelonephritis in children below 18 years of age. We calculated sensitivity, specificity and likelihood ratios. Data were pooled using a bivariate random effects model and a Hierarchical Summary Receiver Operating Characteristic analysis.

Results

Seventy-five moderate to high quality studies were included in this review and 54 articles in the meta-analyses. The area under the receiver-operating-characteristics curve to diagnose cystitis was 0.75 (95%CI 0.62 to 0.83, n = 9) for C-reactive protein, 0.71 (95% CI 0.62 to 0.80, n = 4) for procalcitonin, 0.93 (95% CI 0.91 to 0.96, n = 22) for the dipstick test (nitrite or leukocyte esterase ≥trace), 0.94 (95% CI 0.58 to 0.98, n = 9) for urine white blood cells and 0.98 (95% CI 0.92 to 0.99, n = 12) for Gram-stained bacteria. For pyelonephritis, C-reactive protein < 20 mg/l had LR- of 0.10 (95%CI 0.04–0.30) to 0.22 (95%CI 0.09–0.54) in children with signs suggestive of urinary tract infection.

Conclusions

Clinical prediction rules including the dipstick test biomarkers can support family physicians while awaiting urine culture results. CRP and PCT have low accuracy for cystitis, but might be useful for pyelonephritis.
Appendix
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Metadata
Title
Diagnostic value of biomarkers for paediatric urinary tract infections in primary care: systematic review and meta-analysis
Authors
Hanne A. Boon
Thomas Struyf
Dominique Bullens
Ann Van den Bruel
Jan Y. Verbakel
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-021-01530-9

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