The Role of Procalcitonin and Other Markers of Inflammation in Predicting Spontaneous Passage of Ureteral Stones

Objective: Ureteral stones are monitored for spontaneous passage in cases where there is no indication of interventional treatment. In this prospective study, we aimed to investigate the role of biochemical inflammation factors in predicting spontaneous passage. Methods: Our study was conducted in patients who presented with ureteral stones between August and November 2016, following ethics committee approval and patient consent. The inflammatory markers [white blood cell (WBC), C-reactive protein, sedimentation, mean platelet volume, neutrophil/lymphocyte ratio, procalcitonin in serum; WBC and bacteria in urine] were recorded in 54 patients with 5-10 mm single ureteral stones and no indication for interventional treatment, and a control group of 33 volunteers with the same socio-demographic conditions. Medical expulsive therapy was applied to the case group and followed for 4 weeks. At the end of the follow-up, the case group was divided into two groups as passage (+) and passage (-). The groups' data were compared statistically. Results: Distal localization (70% vs 37.5%; p<0.05) was significantly higher in the passage (+) group than in the passage (-). Procalcitonin (207 +/- 145.1 pg/mL) was significantly higher (p<0.05) in the passage (-) group than in the passage (+) group (132.7 +/- 28.1 pg/mL). In the passage (-) group, the rate of leukocyturia (58.3% vs 20%; p<0.05) was higher than in the passage (+) group. A significant activity of procalcitonin value [0.805 (0.687-0.923) under the curve] was observed in the separation of patients with and without passages. A significant activity of procalcitonin 160 pg/mL cut-off value [0.788 (0.658-0.917) under the curve] was observed in the separation of patients with and without passages. Sensitivity was 86.7%, specificity was 70.8%, positive estimate was 78.8%, negative estimate was 81.0%. Conclusion: Spontaneous passage in ureteral stones can be estimated by looking at serum procalcitonin levels. The receiver operating characteristic curve showed that for serum procalcitonin, the cut-off value of 160 pg/mL may have significant effectiveness. In addition, leukocyturia is also one of the factors that negatively affect spontaneous passage.