Upper Urinary Tract Culture Positivity in Obstructive Ureterolithiasis-Clinical Severity, Inflammatory Biomarkers, and Early Risk Assessment.
4 affiliations
- 1Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania.
- 2Emergency Care Department, "Sf. Spiridon" County University Emergency Hospital, 700111 Iasi, Romania.
- 3Department of Urology, "Dr. C.I. Parhon" Clinical Hospital, 700503 Iasi, Romania.
- 4Department of Urology, "Sf. Ioan cel Nou" County Emergency Hospital, 720033 Suceava, Romania.
Abstract
Background/Objectives: Obstructive ureterolithiasis complicated by infection may progress rapidly to systemic deterioration, while microbiological confirmation is generally unavailable during initial assessment. This study evaluated the association of admission procalcitonin (PCT), National Early Warning Score 2 (NEWS2), and routine urinary parameters with positive upper urinary tract culture in patients requiring urgent urinary decompression. Methods: This retrospective single-center observational study included 240 adults admitted with obstructive ureterolithiasis who underwent upper urinary tract decompression by ureteral stenting or percutaneous nephrostomy. Demographic, clinical, laboratory, and urinary parameters obtained at admission were compared according to upper urinary tract culture status. Factors associated with culture positivity were assessed using univariable and multivariable logistic regression. Four clinically defined models were compared: a reference model containing WBC, CRP, urinary nitrites, and proteinuria; models separately adding PCT or NEWS2; and a complete model containing both. Discrimination was compared using AUCs and the DeLong test, while model fit was assessed using likelihood-ratio tests. Internal validation was performed using 1000 bootstrap resamples. Results: Positive upper urinary tract cultures were identified in 86 patients (35.8%). In the complete model, PCT per doubling (aOR 1.820; 95% CI 1.502-2.205; p < 0.001) and NEWS2 (aOR 1.167; 95% CI 1.014-1.344; p = 0.031) remained independently associated with culture positivity. The reference model had an AUC of 0.691. Adding PCT increased the AUC to 0.831 (ΔAUC 0.140; p < 0.001), whereas adding NEWS2 alone resulted in an AUC of 0.720 (ΔAUC 0.029; p = 0.085). The complete model achieved an apparent AUC of 0.839 and an optimism-corrected AUC of 0.821. After PCT was included, NEWS2 improved overall model fit (p = 0.029) and produced an additional increase in AUC (ΔAUC 0.007; p = 0.448). Conclusions: Admission PCT and NEWS2 were independently associated with positive upper urinary tract culture The combined model showed good discrimination, although external validation is required before clinical application. Urinary nitrite positivity retained an independent association only in the exploratory cut-off-based analysis.
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BibTeX
@article{ivanuța2026upper,
title = {{Upper Urinary Tract Culture Positivity in Obstructive Ureterolithiasis-Clinical Severity, Inflammatory Biomarkers, and Early Risk Assessment.}},
author = {Ana-Maria Ivănuță and Marius Ivănuță and Dragoș Puia and Nicolae Stoican and Diana-Carmen Cimpoeșu and Alexandra Haută and Cătălin Pricop},
journal = {Clinics and practice},
year = {2026},
month = oct,
doi = {10.3390/clinpract16100185},
url = {https://europepmc.org/article/MED/42930371},
note = {CC BY},
}
RIS
TY - JOUR
TI - Upper Urinary Tract Culture Positivity in Obstructive Ureterolithiasis-Clinical Severity, Inflammatory Biomarkers, and Early Risk Assessment.
AU - Ana-Maria Ivănuță
AU - Marius Ivănuță
AU - Dragoș Puia
AU - Nicolae Stoican
AU - Diana-Carmen Cimpoeșu
AU - Alexandra Haută
AU - Cătălin Pricop
PY - 2026
DA - 2026/10/08
JO - Clinics and practice
DO - 10.3390/clinpract16100185
UR - https://europepmc.org/article/MED/42930371
AB - Background/Objectives: Obstructive ureterolithiasis complicated by infection may progress rapidly to systemic deterioration, while microbiological confirmation is generally unavailable during initial assessment. This study evaluated the association of admission procalcitonin (PCT), National Early Warning Score 2 (NEWS2), and routine urinary parameters with positive upper urinary tract culture in patients requiring urgent urinary decompression. Methods: This retrospective single-center observational study included 240 adults admitted with obstructive ureterolithiasis who underwent upper urinary tract decompression by ureteral stenting or percutaneous nephrostomy. Demographic, clinical, laboratory, and urinary parameters obtained at admission were compared according to upper urinary tract culture status. Factors associated with culture positivity were assessed using univariable and multivariable logistic regression. Four clinically defined models were compared: a reference model containing WBC, CRP, urinary nitrites, and proteinuria; models separately adding PCT or NEWS2; and a complete model containing both. Discrimination was compared using AUCs and the DeLong test, while model fit was assessed using likelihood-ratio tests. Internal validation was performed using 1000 bootstrap resamples. Results: Positive upper urinary tract cultures were identified in 86 patients (35.8%). In the complete model, PCT per doubling (aOR 1.820; 95% CI 1.502-2.205; p < 0.001) and NEWS2 (aOR 1.167; 95% CI 1.014-1.344; p = 0.031) remained independently associated with culture positivity. The reference model had an AUC of 0.691. Adding PCT increased the AUC to 0.831 (ΔAUC 0.140; p < 0.001), whereas adding NEWS2 alone resulted in an AUC of 0.720 (ΔAUC 0.029; p = 0.085). The complete model achieved an apparent AUC of 0.839 and an optimism-corrected AUC of 0.821. After PCT was included, NEWS2 improved overall model fit (p = 0.029) and produced an additional increase in AUC (ΔAUC 0.007; p = 0.448). Conclusions: Admission PCT and NEWS2 were independently associated with positive upper urinary tract culture The combined model showed good discrimination, although external validation is required before clinical application. Urinary nitrite positivity retained an independent association only in the exploratory cut-off-based analysis.
SN - 2039-7275
SN - 2039-7283
ER -