Influence of bladder lithiasis on lower urinary tract dynamics in patients with spinal cord injury.

STUDY DESIGN: A prospective and a case-matched control study. OBJECTIVES: To study the lower urinary tract dysfunction associated with bladder lithiasis in patients with spinal cord injury (SCI). SETTING: Toledo (Spain). METHODS: We have carried out a urodynamic study in 30 patients with SCI with lithiasis in their bladder before and 3 months after bladder endoscopic lithotripsy. This second study was compared with the urodynamic findings of a different group of 30 patients with SCI, without a history of bladder lithiasis, paired with cases by gender and date of urodynamic study. RESULTS: We have found that the prevalence of neurogenic detrusor overactivity (NDO) was significantly different after bladder lithotripsy, although the cystomanometric capacity was significantly increased. A group of patients with lithiasis showed a maximum flow rate, a voiding maximum detrusor pressure and the detrusor contractility parameter Wmax lower than that in controls. On the other hand, a voiding abdominal straining was found to be significantly greater than that in controls. CONCLUSIONS: Bladder lithiasis affects the presence of NDO in patients with SCI. Patients with SCI who develop bladder lithiasis present a lower detrusor contractility power compared with those who do not.

Utilidad de la procalcitonina y proteína C reactiva para predecir bacteriemia en las infecciones del tracto urinario en el servicio de urgencias / Usefulness of procalcitonin and C-reactive protein for predicting bacteremia in urinary tract infections in the emergency department

Introducción: El objetivo del estudio fue analizar y comparar la capacidad de la procalcitonina (PCT), proteína C reactiva (PCR), lactato y leucocitos para predecir la existencia de bacteriemia en los pacientes con infección del tracto urinario (ITU). Métodos: Estudio observacional, retroprospectivo y analítico de pacientes adultos (≥ 15 años) diagnosticados de ITU en un servicio de urgencias desde agosto de 2012 hasta enero de 2013. Resultados: Se incluyeron 328 casos diagnosticados de ITU con una edad media de 52 ± 22 años, el 74% mujeres. De ellos 43 (13,1%) con bacteriemia. Para predecir bacteriemia la PCT obtiene la mayor área bajo la curva ROC (ABC-ROC), de 0,993 (IC 95%: 0,987-1, p < 0,001) y con un punto de corte ≥ 1,16 ng/ml se consigue una sensibilidad del 100%, especificidad del 97%, un valor predictivo positivo de 84% y un valor predictivo negativo del 100%. El lactato consigue un ABC-ROC de 0,844 y la PCR solo de 0,534. Los valores medios al comparar la PCT en pacientes con ITU con/sin bacteriemia fueron 8,08 ± 16,37 vs 0,34 ± 0,37 ng/ml, p < 0,001. Conclusiones: En los pacientes con ITU en el servicio de urgencias la PCT consigue un gran rendimiento diagnóstico para sospechar bacteriemia, mayor que el lactato, la PCR y los leucocitos

Introduction: The aim of this study was to analyze and compare the capacity of procalcitonin (PCT), C-reactive protein (CRP), lactate and leukocytes to predict the presence of bacteremia in patients with urinary tract infections (UTIs). Methods: Observational, retro-prospective analytical study of adult patients (≥15 years) diagnosed with UTI in an emergency department from August 2012 to January 2013. Results: The study included 328 patients diagnosed with UTI, with a mean age of 52 ± 22 years, 74% of whom were women. Of these, 43 (13.1%) had bacteremia. For predicting bacteremia, PCT achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at .993 (95% CI .987-1; P < .001). A cutoff ≥ 1.16 ng/mL achieves a sensitivity of 100%, a specificity of 97%, a positive predictive value of 84% and a negative predictive value of 100%. Lactate achieved an ROC-AUC of .844, and CRP achieved only .534. The mean values when comparing PCT levels in patients with UTIs with and without bacteremia were 8.08 ± 16.37 and .34 ± .37 ng/mL, respectively (P < .001). Conclusions: For patients with UTIs in the emergency department, PCT achieves considerable diagnostic performance for suspecting bacteremia, a performance greater than that of lactate, CRP and leukocytes

Usefulness of procalcitonin and C-reactive protein for predicting bacteremia in urinary tract infections in the emergency department.

INTRODUCTION: The aim of this study was to analyze and compare the capacity of procalcitonin (PCT), C-reactive protein (CRP), lactate and leukocytes to predict the presence of bacteremia in patients with urinary tract infections (UTIs). METHODS: Observational, retro-prospective analytical study of adult patients (≥15 years) diagnosed with UTI in an emergency department from August 2012 to January 2013. RESULTS: The study included 328 patients diagnosed with UTI, with a mean age of 52±22 years, 74% of whom were women. Of these, 43 (13.1%) had bacteremia. For predicting bacteremia, PCT achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at .993 (95% CI .987-1; P<.001). A cutoff≥1.16ng/mL achieves a sensitivity of 100%, a specificity of 97%, a positive predictive value of 84% and a negative predictive value of 100%. Lactate achieved an ROC-AUC of .844, and CRP achieved only .534. The mean values when comparing PCT levels in patients with UTIs with and without bacteremia were 8.08±16.37 and .34±.37ng/mL, respectively (P<.001). CONCLUSIONS: For patients with UTIs in the emergency department, PCT achieves considerable diagnostic performance for suspecting bacteremia, a performance greater than that of lactate, CRP and leukocytes.