Clinical relevance of postoperative biomarkers in pediatric endourology: is procalcitonin telling the truth?

Abstract

Purpose: Although acute phase reactants (APRs) are widely used in the postoperative period in various procedures, no clear recommendations exist for their clinical use in pediatric stone disease. We aimed to evaluate the clinical utility of APRs to diagnose UTI and urosepsis in pediatric endourological postoperative courses. Methods: This case-control study retrospectively analyzed pediatric patients who underwent endourological intervention for stone disease in a single, tertiary referral center. Serum levels of white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) were assessed on postoperative days (POD)- 0 and 1. Risk factors and cut-off values of APRs for infectious complications were assessed with multivariate and ROC analyses. Results: We included 223 children, in whom UTI developed in 14 % and urosepsis in 5 % of patients. Leucocyte esterase activity in preoperative urine analysis, total diameter of stones and the duration of surgery were found to differ in patients with UTI, whereas in patients with urosepsis, a difference was only observed in the duration of surgery among parameters. The highest area under the curve was reached with POD-1 PCT, in detecting UTI (AUC: 0.778) with a cut-off value of 0.29 μg/L and urosepsis (AUC: 0.901) with a cut-off value of 0.62 μg/L. Conclusion: Patients with a prolonged duration of surgery are at risk for infectious complications. To monitor these high-risk patients, PCT is highly specific in serum levels higher than 0.29 μg/L for UTI and 0.62 μg/L for urosepsis. Multicentric and prospective studies are needed to validate and confirm these results.