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. 2024 May-Jun;38(3):1542-1552.
doi: 10.1111/jvim.17082. Epub 2024 Apr 26.

Usefulness of serum amyloid A for the diagnosis of pyelonephritis in cats: A prospective evaluation

Maxime Kurtz  1 , Pascaline Bénédicte Marie Pey  2   3 , Jérémy Mortier  4 , Mathieu Manassero  5 , Fiona Da Riz  1 , Morgane Canonne-Guibert  1   4 , Christelle Maurey  1 , Ghita Benchekroun  1   6
Affiliations

Usefulness of serum amyloid A for the diagnosis of pyelonephritis in cats: A prospective evaluation

Maxime Kurtz et al. J Vet Intern Med. 2024 May-Jun.

Abstract

Background: The diagnosis of pyelonephritis in cats is challenging and development of a noninvasive and accurate biomarker is needed.

Hypotheses: Serum amyloid A (SAA) is increased in cats with pyelonephritis, but not in cats with other urinary tract diseases.

Animals: A cohort of 125 cats (149 observations).

Methods: This was a prospective study. Group 1 included cats with a diagnosis of pyelonephritis either confirmed by bacterial culture of pelvic urine (Group 1a) or presumed (1b). Group 2 included cats for which pyelonephritis was ruled out (with certainty: Group 2a or judged unlikely: Group 2b). SAA concentration was compared between groups, and accuracy of SAA for the diagnosis of pyelonephritis was calculated using a Receiver Operating Characteristic (ROC) curve analysis.

Results: Median SAA concentration was significantly higher in Group 1a (86.8 mg/L [73.3; 161.5]; n = 8) than in Group 2a (4 mg/L [1.8; 5.6], n = 19; P < .001) and in Group 2b (5.4 mg/L [3.1; 9.7], n = 113; P < .001). It was also significantly higher in Group 1b (98.8 mg/L [83.1; 147.3]; n = 9) than in Group 2b (P < .001) and Group 2a (P < .001). Optimal diagnostic cut-off for SAA concentration was 51.3 mg/L. yielding a sensitivity of 88% (95% confidence interval: [64%; 99%]) and a specificity of 94% (95% confidence interval: [88%; 97%]).

Conclusions and clinical importance: Measurement of SAA could be used to rule out pyelonephritis in the case of low suspicion of the disease. Increased SAA concentration is suggestive of pyelonephritis despite a lack of specificity.

Keywords: antibiotics; biomarker; pelvic cavity; renal; urinary tract infection.

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Conflict of interest statement

Authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart representation of the process of inclusion, exclusion, and group allocation in the study sample.
FIGURE 2
FIGURE 2
Box plots representing the concentration of Serum Amyloid A (SAA) in the different groups of the study sample. Group 1a and Group 2a: cats with confirmed/excluded pyelonephritis based on positive/negative bacterial culture on urine collected by pyelocentesis, respectively. Group 1b and 2b: cats with pyelonephritis being judged likely or unlikely based on clinical and biological criteria (see material and methods).
FIGURE 3
FIGURE 3
(A) Receiving Operating Characteristics (ROC) curve for the ability of SAA concentration to detect pyelonephritis, that is, to differentiate cats from Group 1 (cats with confirmed or presumed pyelonephritis) and 2 (cats with pyelonephritis being excluded or judged unlikely). (B) same curve after exclusion of cats that had received antibiotics before presentation.
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