Is mid-regional pro-atrial natriuretic peptide (MRproANP) an accurate marker of bacteremia in pyelonephritis?

Abstract

Introduction: Mid-regional pro-atrial natriuretic peptide (MRproANP) increases during systemic infections and could possibly correlate with bacteremia.

Methods: We determined the characteristics of MRproANP for accuracy to detect positive blood culture.

Results: Bacteremia was positive in 58 (15%) of 347 patients. MRproANP levels increased in patients with bacteremia (98.4 pmol/L [interquartile range (IQR) 68.2–153.1] vs. 66.4 pmol/L [IQR 51.0-90.3], p < 0.01). Performance of MRproANP to predict bacteremia [AUC = 0.69, 95%CI: 0.61–0.77] was equivalent to C-reactive protein (0.66 [95%CI: 0.59–0.74], p = 0.53) but less accurate than procalcitonin (0.78 [95%CI: 0.72–0.84], p < 0.001).

Conclusion: Although MRproANP increased in bacteremic patients with acute pyelonephritis, results of likelihood ratios discarded its use at bedside to predict bacteremia.

Keywords::

• Bacteremia
• urinary tract infection
• biomarkers
• procalcitonin
• mid-regional pro-atrial natriuretic peptide
• emergency medicine

Acknowledgement

AUC, areas under receiving–operating curves; SD, standard deviation; 95% CI, 95% confidence interval.

We are indebted to J-M. Treluyer, R. Serreau, M. Anoussamy, C. Klochendler, S. Colas, and the staff of the Clinical Research Department (Unite´ de Recherche Clinique, URC) Cochin-Paris Centre for their valuable technical and logistical support. We wish to thank R. Lecomte and Brahms Inc. for providing the Kryptor and corresponding reagents to obtain high-quality estimations of PCT and ANP. We thank O. Ekindjian who supervised estimation of biomarkers. We acknowledge P. Gerbeaux, J. Charpentier, and D. Boutoille, who reviewed each patient’s chart for the need for admission.

This study was funded by the ‘Délégation Régionale de la Recherche Clinique’, APHP, Paris, France and a grant from the “Programme Hospitalier de Recherche Clinique”, 2003. This study was conducted on behalf the BIS Study Group: Cochin (Paris, France): J-C. Allo, C. Barbotin, J-C. Boulard, Y-E. Claessens (P.I), A. Dabreteau, G. Der Sahakian, J.F Dhainaut (P.I), S. Esain, A. Gayet, C. Ginsburg, I. Iraqi-Chentouf, J. Kansao, F. Lecomte, I. Mazariegos, O. Meyniard, F. Perruche, S. Pineau, R. Ranerison, K. Takun, C. Vartanian, L. Zarnitsky; Pitié-Salpétrière (Paris, France): R. Achkar, K. An, A. Arhan, M. Bendahou, J-F. Benezet, P. Bonnet, A. Dardalon, N Delot-ElFakhri, S. Delerm, P. Hausfater, M-O. Josse, J-S. Marx, B. Madonna-Py, P. Ray, B. Riou, K. Saighi, B. Wellner; Hopital Caremeau (Nımes, France): P-G. Claret, J-E. de la Coussaye, T. Duclos, J. Flechet, P. Fournier, A. Gache, F. Hernandez, C. Hilaire, F. Jourdan, G. Kayser, S. Louvard, O. Onde, O. Paul, I. Rajeebally, P. Richard, H. Robert, J. Rousset, E. Vernes, P. Wagner-Kerdranvat; Hopital Gabriel Montpied (Clermont-Ferrand, France): C. Billault, S. Boizat, A. Bommelaer, J-L. Buisson, C. Carrias, M. Entwhistle, E. Jehle, A. Lenat, J. Liotier, T. Mathevon, C. Perrier, D. Pic, C. Pourrat, C. Rougier, J. Schmidt, F. Vaysse; Hotel-Dieu (Nantes, France): I. Arnaudet, N. Asseray-Madani, P. Auneau, E. Batard (P.I), J. Dary, S. DiBernardo, D. ElKouri, C. Ferron, I. Gueffet, J. Jenvrin, V. Kuczer, P. Leconte, E. Legeard, C. Longo, J. Lorber, G. Potel, M-D. Touze, D. Trewick, F. Vignaud, D. Yatim-Lequeret; Hotel-Dieu (Paris, France): M. Baud, M-L. Catinois, D. Cantin-Bertaux, F. Dumas, T. Jactat, L. Kachout, G. Kierzek, E. Hinglais, G. LeGuerrroue, J-L. Pourriat, F. Trarieux, C. Wertheimer; Hopital Européen Georges-Pompidou (Paris, France): M. Aitkaci, M-C. Ballester, M. Bouyx, T-H. Cao, A. Davido, A. Gounaropoulos, A. Levy, O. Limaiem-Joumni, R. Masmoudi, C. Moreau, P. Meraud, A. Patzak, M-P. Playe, M-P. Sadier, N. Smbach, A. Severin, C. Vidal; Hopital Bicêtre (Kremlin-Bicêtre, France): C. Choquet, J. Depret-Vassal, T. Gudj, S. Sarnel; Hopital Bichat-Claude Bernard (Paris, France): M. Aliouane, E. Casalino, M. Dimitroff, L-B. Rimaud, P. Werner; Hopital Jean-Verdier (Bondy, France): J. Benkel, B. Bernot, C. Chassaignon, E. Debuc, G. Lenoir, D. Pateron (P.I), F. Pevirieri; Hopital Lariboisière (Paris, France): C. Aparicio, J. Boni-Malka, J-P. Courret, A. Debatisse, B. Galichon, S. Gallula, P.Gamand, S. Laribi, K. Mezaib, L. Pasgrimaud, F. Penit, P. Plaisance, F. Renai; Hopital Louis Mourier (Colombes, France): A. Briere-Savard, P. Brun (P.I), B. Canderan, S. Hirsch, C. Lagarde, C. Leroy, F. Nikpay-Aslie, R. Sadat, F. Tessiere; Hopital Sainte-Camille (Bry-sur-Marne, France): P. Collet, P. Hamlin, P. Lebrin, C. Loyer, G. Pinello, L. V-P. Vong; Hopital Beaujon (Clichy, France): P. Juvin, L. Lavagna-Perez.

S.G.B. participated in the design of the protocol, analysis of the results and drafting of the manuscript. S. Grabar participated in the design of the study and critical revision of the manuscript. C.C.G. participated in the biochemical analysis of the blood samples and critical revision of the manuscript. L.Q. performed the statistical analysis. S. Guerin was responsible for the biochemical analysis of the blood samples. J.S., G.K., P.H., B.B., C.L., A.G., E.C., and N.T. were involved in local organization of the study. B.R. participated in the critical revision of the manuscript. Y.E.C. conceived the study, participated in the design and coordination of the protocol, obtained the funding, carried out main study analysis, and drafted the manuscript. All authors read and approved the final manuscript.

Declaration of interest

Brahms Inc. provided the Kryptor device and corresponding reagents to obtain PCT and MRproANP measurements.