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. 2017 Dec;140(6):e20171090.
doi: 10.1542/peds.2017-1090. Epub 2017 Nov 16.

Urinary Neutrophil Gelatinase-Associated Lipocalin for the Diagnosis of Urinary Tract Infections

Tamar R Lubell  1 , Jonathan M Barasch  2 , Katherine Xu  2 , Maria Ieni  3 , Keven I Cabrera  3 , Peter S Dayan  3
Affiliations

Urinary Neutrophil Gelatinase-Associated Lipocalin for the Diagnosis of Urinary Tract Infections

Tamar R Lubell et al. Pediatrics. 2017 Dec.

Abstract

Objectives: To determine the accuracy of the novel biomarker urinary neutrophil gelatinase-associated lipocalin (uNGAL) to diagnose urinary tract infections (UTIs) in febrile infants and young children.

Methods: Prospective cross-sectional study of febrile infants <3 months ( ≥ 38.0°C) and children 3 to 24 months (≥ 39.0°C) evaluated for UTIs. uNGAL levels, urinalysis, Gram-stain and culture were obtained. UTI was defined by colony counts.

Results: Of 260 patients, 35 (13.5%) had UTIs. Median uNGAL levels were 215.1 ng/mL (interquartile range: 100.3-917.8) and 4.4 ng/mL (interquartile range: 1.6-11.8) in the groups diagnosed with and without UTIs, respectively. The area under the receiver-operating characteristic curve for uNGAL was 0.978 (95% confidence interval [CI]: 0.948-1.000). At a threshold uNGAL level of 39.1 ng/mL, sensitivity was 97.1% (95% CI: 83.4-99.9) and specificity was 95.6% (95% CI: 91.7-97.7). uNGAL had higher sensitivity than the combination of leukocyte esterase (in trace or greater amounts) or nitrite (+) (97.1%, 95% CI: 83.4-99.9 vs 74.3%, 95% CI: 56.4-86.9), with similar specificity (95.6%, 95% CI: 91.7-97.7 vs 97.3%, 95% CI: 94.0-98.9). uNGAL had higher sensitivity than Gram-stain (97.1%, 95% CI: 83.4-99.9 vs 74.3%, 95%: CI: 56.4-86.9), with similar specificity (95.6%, 95% CI: 91.7-97.7 vs 100.0%, 95% CI: 97.9-100.0).

Conclusions: uNGAL has substantial accuracy to identify those with and without UTIs in infants and young children. Further studies will need to confirm our findings and determine if uNGAL is a more cost-effective test than standard screening tests.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: All authors are employed by Columbia University, which has issued and submitted patents for the use of neutrophil gelatinase–associated lipocalin in diagnostics.

Figures

FIGURE 1. Flow diagram.
FIGURE 1
Flow diagram.
FIGURE 2. uNGAL levels in each UTI group. The scatter plot with box-and-whisker graph shows patient data points with boxes indicating the 25th and 75th percentiles, horizontal lines in each box indicating median values, whiskers marking the maximum and minimum values, and stars denoting outliers. Horizontal line represents the uNGALthreshold of 39.1 ng/mL.
FIGURE 2
uNGAL levels in each UTI group. The scatter plot with box-and-whisker graph shows patient data points with boxes indicating the 25th and 75th percentiles, horizontal lines in each box indicating median values, whiskers marking the maximum and minimum values, and stars denoting outliers. Horizontal line represents the uNGALthreshold of 39.1 ng/mL.
FIGURE 3. ROC curve for uNGAL for the diagnosis of UTI (definite and possible).
FIGURE 3
ROC curve for uNGAL for the diagnosis of UTI (definite and possible).
See this image and copyright information in PMC

References

    1. Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr. 1993;123(1):17–23 - PubMed
    1. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008;27(4):302–308 - PubMed
    1. Shaw KN, Gorelick M, McGowan KL, Yakscoe NM, Schwartz JS. Prevalence of urinary tract infection in febrile young children in the emergency department. Pediatrics. 1998;102(2). Available at: www.pediatrics.org/cgi/content/full/102/2/e16 - PubMed
    1. Shaw KN, McGowan KL, Gorelick MH, Schwartz JS. Screening for urinary tract infection in infants in the emergency department: which test is best? Pediatrics. 1998;101(6). Available at: www.pediatrics.org/cgi/content/full/101/6/e1 - PubMed
    1. Gorelick MH, Shaw KN. Screening tests for urinary tract infection in children: A meta-analysis. Pediatrics. 1999;104(5). Available at: www.pediatrics.org/cgi/content/full/104/5/e54 - PubMed