Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 9:11:1163546.
doi: 10.3389/fped.2023.1163546. eCollection 2023.

Biomarkers for febrile urinary tract infection in children

Nader Shaikh  1 , Marcia Kurs-Lasky  1 , Hui Liu  1 , Vinod Rajakumar  1 , Heba Qureini  1 , Isabella O Conway  1 , Matthew C Lee  1 , Sojin Lee  1
Affiliations

Biomarkers for febrile urinary tract infection in children

Nader Shaikh et al. Front Pediatr. .

Abstract

Background: The current reference standard for pediatric urinary tract infection (UTI) screening, the leukocyte esterase (LE) dipstick test, has suboptimal accuracy. The objective of this study was to compare the accuracy of novel urinary biomarkers to that of the LE test.

Methods: We prospectively enrolled febrile children who were evaluated for UTI based on their presenting symptoms. We compared the accuracy of urinary biomarkers to that of the test.

Results: We included 374 children (50 with UTI, 324 without UTI, ages 1-35 months) and examined 35 urinary biomarkers. The urinary biomarkers that best discriminated between febrile children with and without UTI were urinary neutrophil gelatinase-associated lipocalin (NGAL), IL-1β, CXCL1, and IL-8. Of all examined urinary biomarkers, the urinary NGAL had the highest accuracy with a sensitivity of 90% (CI: 82-98) and a specificity of 96% (CI: 93-98).

Conclusion: Because the sensitivity of the urinary NGAL test is slightly higher than that of the LE test, it can potentially reduce missed UTI cases. Limitations of using urinary NGAL over LE include increased cost and complexity. Further investigation is warranted to determine the cost-effectiveness of urinary NGAL as a screening test for UTI.

Keywords: biomarker; diagnostic accuracy; infectious disease; microbiome; urinary tract infection (UTI).

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow of patients in the study.
Figure 2
Figure 2
Box and whisker plot of urinary NGAL level in children with and without UTI. Dots represent outliers. Diamonds represent group means. NGAL, neutrophil gelatinase–associated lipocalin; UTI, urinary tract infection.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC. Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis. Lancet Infect Dis. (2010) 10:240–50. 10.1016/S1473-3099(10)70031-1 - DOI - PubMed
    1. Saha D, Patel J, Buckingham D, Thornton D, Barber T, Watson JR. Urine culture follow-up and antimicrobial stewardship in a pediatric urgent care network. Pediatrics. (2017) 139. 10.1542/peds.2016-2103 - DOI - PubMed
    1. Watson JR, Sanchez PJ, Spencer JD, Cohen DM, Hains DS. Urinary tract infection and antimicrobial stewardship in the emergency department. Pediatr Emerg Care. (2018) 34:93–5. 10.1097/PEC.0000000000000688 - DOI - PubMed
    1. Jung N, Byun HJ, Park JH, Kim JS, Kim HW, Ha JY. Diagnostic accuracy of urinary biomarkers in infants younger than 3 months with urinary tract infection. Korean J Pediatr. (2018) 61:24–9. 10.3345/kjp.2018.61.1.24 - DOI - PMC - PubMed
    1. Lijmer JG, Mol BW, Heisterkamp S, Bonsel GJ, Prins MH, van der Meulen JH, et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA. (1999) 282:1061–6. 10.1001/jama.282.11.1061 - DOI - PubMed