Concomitant emphysema might increase the false-negative rate of urinary antigen tests in patients with pneumococcal pneu
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ORIGINAL ARTICLE
Concomitant emphysema might increase the false-negative rate of urinary antigen tests in patients with pneumococcal pneumonia: results from a retrospective study Erika Kobayashi 1 & Kakuhiro Yamaguchi 1 & Rie Nagaoka 2 & Shinjiro Sakamoto 1 & Yasushi Horimasu 1 & Takeshi Masuda 1 & Shintaro Miyamoto 1 & Taku Nakashima 1 & Hiroshi Iwamoto 1 & Kazunori Fujitaka 1 & Michiya Yokozaki 2 & Hiroki Ohge 3 & Hironobu Hamada 4 & Noboru Hattori 1 Received: 23 June 2020 / Accepted: 30 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The urinary antigen test (UAT) is a rapid diagnostic method for pneumococcal pneumonia, but the high false-negative rate of 30% may affect its reliability. To maximize the utility of UAT, it is necessary to investigate the patient factors affecting UAT results. However, there is no report elucidating the association between its utility and pre-existing lung abnormalities. We retrospectively reviewed 388 patients with pneumococcal pneumonia confirmed by blood and/or sputum culture tests. Finally, 94 of 388 patients who had the results of UAT and computed tomography scans were enrolled to evaluate the association between the utility of UAT and patient factors including pulmonary emphysema and fibrosis. The overall positive rate of UAT was 69.1%. The positive rates of UAT in the patients with emphysema were significantly lower than those in individuals without emphysema (33.3% and 77.6%, p < 0.001). Univariate logistic regression analysis showed that the presence of emphysema was associated with a low positive rate (odds ratio 6.944, 95% confidence interval 2.268–21.231). Multivariate logistic analysis showed that the presence of emphysema and lower levels of serum blood urea nitrogen (BUN) were significantly and independently associated with a low positive rate. The combination of emphysema and BUN can potentially stratify the positive rate of UAT in patients with pneumococcal pneumonia. Patients with pneumococcal pneumonia and emphysema have a lower positive rate of UAT. Additionally, the combination of emphysema and serum BUN value may be useful to evaluate the reliability of the negative results of pneumococcal UAT. Keywords Emphysema . Urinary antigen test . Streptococcus pneumoniae . Blood culture
Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10096-02004095-0. * Kakuhiro Yamaguchi [email protected] 1
Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
2
Division of Clinical Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
3
Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
4
Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
Introduction Streptococcus pneumoniae (S. pneumoniae) is the most com
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