Do Bun/Albumin and Crp/Albumin Guide the Discrimination of Upper and Lower Urinary Tract Infections?

Year 2023, Volume: 3 Issue: 2, 14 - 21, 31.08.2023

Ecem Ermete Güler , Umut Payza , Tutku Duman Şahan , Zeynep Özel

Abstract

Objectives: Urinary system infections are one of the common causes of admission to the emergency department. And in this patient group, the distinction between upper and lower urinary tract is important in patient follow-up and treatment. The aim of this study is to investigate the usability of CAR and BAR values in the differentiation of lower and upper urinary tract infections in urinary tract infections presenting to the emergency department. Our secondary aim is to investigate the mortality predictive power of CAR and BAR values in urinary tract infections admitted to the emergency department.
Material and Methods: The study was planned as a retrospective observational. Patients diagnosed with urinary system infection in the emergency department were included in the study. Patient information was collected over the existing hospital data recording system and used for statistical analysis. The patients were divided into 2 groups as lower and upper urinary tract infections, and the usability of CAR and BAR values in this division was calculated.
Results: A total of 41 patients were included in the study and 17 of them were women. The mean age of all patients was calculated as 70.66±14.47 years. While 32 of the patients were lower urinary tract infections, 9 of them were upper urinary tract infections. 8 patients resulted in mortality. It was found that CAR and BAR values were not statistically significant in estimating mortality with the distinction of upper and lower urinary tract.
Conclusion: CAR and BAR values are not successful markers that can be used to differentiate the lower and upper urinary tract infection.

Keywords

BUN/albumin ratio, CRP/Albumin, urinary tract infections

Üst ve Alt Üriner Sistem Enfeksiyonlarinin Ayrımında Bun/Albumin ve Crp/Albumin Yol Gösterici Midir?

Abstract

Amaç: Üriner sistem enfeksiyonları acil servise sık başvuru sebeplerinden bir tanesidir ve bu hasta gurubunda alt ile üst üriner sistem ayrımı hasta takip ve tedavisinde önem arz etmektedir. Bu çalışmanın amacı acil servise başvuran üriner sistem enfeksiyonlarında alt ve üst üriner sistem enfeksiyonu ayrımında CRP/Albumin oranı (CAR) ve BUN/Albumin oranı (BAR) değerlerinin kullanılabilirliğini araştırmaktır. İkincil amacımız ise acil servise başvuran üriner sistem enfeksiyonlarında CAR ve BAR değerinin mortalite tahmin gücünü araştırmaktır.
Gereç ve Yöntemler: Çalışma retrospektif gözlemsel olarak planlanmıştır. Acil serviste üriner sistem enfeksiyonu tanısı konulan hastalar çalışmaya dahil edilmiştir. Hasta bilgileri mevcut hastane veri kayıt sistemi üzerinden toplanıp istatistiksel analiz için kullanılmıştır. Hastalar alt ve üst üriner sistem enfeksiyonları olarak 2 gruba ayrılmış ve bu ayırımda CAR ve BAR değerlerinin kullanılabilirliği hesaplanmıştır.
Bulgular: Çalışmaya toplam 41 hasta dahil edilmiş olup 17 tanesi kadındır. Tüm hastaların yaş ortalaması 70,66±14,47 olarak hesaplanmıştır. Hastalardan 32 tanesi alt üriner sistem enfeksiyonu iken 9 tanesi üst üriner sistem enfeksiyonudur. 8 hasta mortalite ile sonuçlanmıştır. CAR ve BAR değerlerinin alt ve üst üriner sistem ayırımı ile mortalite tahmininde istatistiksel anlamlı belirteçler olmadığı bulunmuştur.
Sonuç: CAR ve BAR değerleri alt ve üst üriner sistem enfeksiyonu ayrımında kullanılabilecek başarılı belirteçler değildir.

Keywords

BUN/Albumin oranı, CRP/Albumin oranı, üriner sistem enfeksiyonları

References

• Urbschat A, Obermüller N, Paulus P, Reissig M, Hadji P, Hofmann R, Geiger H, Gauer S. Upper and lower urinary tract infections can be detected early but not be discriminated by urinary NGAL in adults. Int Urol Nephrol. 2014 Dec;46(12):2243-9. doi: 10.1007/s11255-014-0831-x.
• Leung AKC, Wong AHC, Leung AAM, Hon KL. Urinary Tract Infection in Children. Recent Pat Inflamm Allergy Drug Discov 2019;13:2‐18. (doi:10.2174/1872213X13666181228154940).
• Xu RY, Liu HW, Liu JL, Dong JH. Procalcitonin and C-reactive protein in urinary tract infection diagnosis. BMC Urol 2014;14:45. ( doi:10.1186/1471-2490-14-45).
• Anger JT, Saigal CS, Wang M, Yano EM; Urologic Diseases in America Project. Urologic disease burden in the United States: veteran users of Department of Veterans Affairs healthcare. Urology. 2008 Jul;72(1):37-41; discussion 41. doi: 10.1016/j.urology.2007.11.163.
• Ki M, Park T, Choi B, Foxman B. The epidemiology of acute pyelonephritis in South Korea, 1997-1999. Am J Epidemiol. 2004 Nov 15;160(10):985-93. doi: 10.1093/aje/kwh308.
• Güneş H, Kütükçü M. Use of CRP/Albumin Ratio In The Differentiation of Upper Urinary System Infection In Children With A Urinary System Infection. Ankara Med J. 2020; 20(4): 895-903. doi: 10.5505/amj.2020.22438.
• Efgan MG, Payza U, Çınaroğlu OS, Acar H, Kayalı A. A Comparison of BUN/Albumin Ratio with PSI and CURB-65 for Predicting Mortality in COVID-19 Pneumonia in the Emergency Department. İstanbul Med J 2022; 23(4): 296-300. doi: 10.4274/imj.galenos.2022.29794.
• Kim BK, Yim HE, Yoo KH. Plasma neutrophil gelatinase-associated lipocalin: a marker of acute pyelonephritis in children. Pediatr Nephrol 2017;32:477‐84. doi:10.1007/s00467-016-3518-y.
• DomínguezdeVillotaE,MosqueraJM,RubioJJ,etal.Association of a low serum albumin with infection and increased mortality in critically ill patients. Intensive Care Med 1980;7:19-22. (doi: 10.1007/bf01692917).
• Mantadakis E, Plessa E, Vouloumanou EK, Karageorgopoulos DE, Chatzimichael A, Falagas ME. Serum procalcitonin for prediction of renal parenchymal involvement in children with urinary tract infections: a meta-analysis of prospective clinical studies.J Pediatr 2009;155:875‐81.e1.(doi:10.1016/j.jpeds.2009.06.037).
• Shaikh N, Borrell JL, Evron J, Leeflang MM. Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev 2015;1:CD009185. (doi:10.1002/14651858.CD009185.pub2).
• Park JE, Chung KS, Song JH, Kim SY, Kim EY, Jung JY, Kang YA, Park MS, Kim YS, Chang J, Leem AY. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J Clin Med. 2018 Oct 8;7(10):333. doi: 10.3390/jcm7100333.
• Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One. 2013;8(3):e59321. doi: 10.1371/journal.pone.0059321. Epub 2013 Mar 12.
• Xu HJ, Ma Y, Deng F, Ju WB, Sun XY, Wang H. The prognostic value of C-reactive protein/albumin ratio in human malignancies: an updated meta-analysis. Onco Targets Ther. 2017 Jun 19;10:3059-3070. doi: 10.2147/OTT.S137002.
• Dundar, Z. D., Kucukceran, K., & Ayranci, M. K. (2021). Blood urea nitrogen to albumin ratio is a predictor of in-hospital mortality in older emergency department patients. The American Journal of Emergency Medicine, 46, 349-354. doi: 10.1016/j.ajem.2020.10.008.
• Ugajin M, Yamaki K, Iwamura N, Yagi T, Asano T. Blood urea nitrogen to serum albumin ratio independently predicts mortality and severity of community-acquired pneumonia. Int J Gen Med. 2012;5:583-9. doi: 10.2147/IJGM.S33628.
• Küçükceran K, Ayrancı MK, Girişgin AS, Koçak S, Dündar ZD. The role of the BUN/albumin ratio in predicting mortality in COVID-19 patients in the emergency department. Am J Emerg Med. 2021 Oct;48:33-37. doi: 10.1016/j.ajem.2021.03.090.