Exploring inflammatory status in febrile seizures associated with urinary tract infections: a Two-Step cluster approach

Background: Urinary tract infections (UTI) are considered as common facilitating factors along with other infections in triggering febrile seizures (FS). The main purpose of the study is to identify specific patterns of UTIs, using a combination of inflammatory biomarkers, in order to differentiate UTIs from other bacterial diseases associated with FS.

Method: This study included a number of 197 distinct FS events, from patients hospitalized in the Sibiu Pediatric Hospital, among which 10.2% were diagnosed with UTIs. Results: In one third of patients with UTIs symptoms were limited to fever and FS. Using Two-Step cluster analysis, a distinct inflammatory pattern has emerged: higher PDW (median value 9,65 fl), P-LCR (median value 14,45%), VTM (median value 10,40 fl), PCR (median value 74,00 g/L) and neutrophil-lymphocyte ratio (median value 3,64), associated mainly (85,7%) with bacterial respiratory infections. UTIs were highly unlikely in the patients with significantly increased PCR values and normal values of platelet indices.

Conclusion. Considering the nonspecific clinical picture of UTIs at an early age, in order to optimize the management of FS a fast diagnosis of UTI is mandatory. Our study suggests that analyzing the inflammatory biomarkers interlink (rather than individual parameters) could help identify UTI patients, even when oligosymptomatic.