Population-specific Urinalysis Parameters Are Necessary to Improve Diagnostic Value for Urinary Tract Infection

We were excited to see the work published by Advani, et al. evaluating the predictive value of positive urinalyses (UA) parameters to diagnose urinary tract infection (UTI) in hospitalized adults.This study evaluated 3,392 randomly-selected hospitalized patients (female 60%, median age 67), performed chart review to assess if UTI was clinically described, and assessed sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) with area under the receiver operating curve (AUROC) of pyuria, nitrite, leukocyte esterase, and bacteriuria in predicting UTI, not just bacteriuria.We applaud the authors for describing inherent challenges of developing UA parameters that reliably inform UTI diagnosis across different patient populations.They report that no single UA parameter had high sensitivity, defined as ≥95%, and that the NPV of pyuria, leukocyte esterase and nitrite differed based on age and sex.The title of the manuscript and their balanced discussion highlight the important issue that UA parameters may vary based on gender, age, and symptoms.Patient's presenting location, although not explored in this study, should also be considered.Gender differences in the predictive value of UA for UTI have been described previously (2); although many studies exclude men or have significantly less male representation, which limits