Ann Lab Med.  2014 Sep;34(5):354-359. 10.3343/alm.2014.34.5.354.

Evaluation of the Optimal Neutrophil Gelatinase-Associated Lipocalin Value as a Screening Biomarker for Urinary Tract Infections in Children

• Kim BH
• Yu N
• Kim HR
• Yun KW
• Lim IS
• Kim TH
• Lee MK

• KMID: 1791949
• DOI: http://doi.org/10.3343/alm.2014.34.5.354

Abstract

BACKGROUND
Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker in the detection of kidney injury. Early diagnosis of urinary tract infection (UTI), one of the most common infections in children, is important in order to avert long-term consequences. We assessed whether serum NGAL (sNGAL) or urine NGAL (uNGAL) would be reliable markers of UTI and evaluated the appropriate diagnostic cutoff value for the screening of UTI in children.
METHODS
A total of 812 urine specimens and 323 serum samples, collected from pediatric patients, were analyzed. UTI was diagnosed on the basis of culture results and symptoms reported by the patients. NGAL values were measured by using ELISA.
RESULTS
NGAL values were more elevated in the UTI cases than in the non-UTI cases, but the difference between the values were not statistically significant (P=0.190 for sNGAL and P=0.064 for uNGAL). The optimal diagnostic cutoff values of sNGAL and uNGAL for UTI screening were 65.25 ng/mL and 5.75 ng/mL, respectively.
CONCLUSIONS
We suggest that it is not appropriate to use NGAL as a marker for early diagnosis of UTI in children.

Keyword

Neutrophil gelatinase associated lipocalin; Screening; Urinary tract infection

MeSH Terms

Acute-Phase Proteins/*urine
Area Under Curve
Biological Markers/blood/urine
Child
Child, Preschool
Early Diagnosis
Enzyme-Linked Immunosorbent Assay
Female
Humans
Infant
Lipocalins/*blood/*urine
Male
Mass Screening/*methods
Proto-Oncogene Proteins/*blood/*urine
ROC Curve
Urinary Tract Infections/*blood/*urine
Acute-Phase Proteins
Biological Markers
Lipocalins
Proto-Oncogene Proteins

Figure

• 

  Fig. 1 ROC curves to detect urinary tract infection (UTI). The blue line is ROC curve for serum neutrophil gelatinase-associated lipocalin (sNGAL) (area under the curve [AUC]=0.534; 95% CI, 0.308-0.812). By using a cutoff value of 65.25 ng/mL for the diagnosis of UTI, sensitivity and specificity were 70% and 35%, respectively (blue dot). The red line is ROC curve for urine neutrophil gelatinase-associated lipocalin (uNGAL) (AUC=0.576; 95% CI, 0.347-0.799). By using a cutoff value of 5.75 ng/mL for the diagnosis of UTI, sensitivity and specificity were 70% and 42%, respectively (red dot).

• 

  Fig. 2 ROC curves to detect urinary tract infection (UTI) defined by the presence or absence of pyuria. The blue line is ROC curve for serum neutrophil gelatinase-associated lipocalin (sNGAL) (area under the curve [AUC]=0.675; 95% CI, 0.372-0.845). By using a cutoff value of 82.5 ng/mL for the diagnosis of UTI, sensitivity and specificity were 70% and 60%, respectively (blue dot). The red line is ROC curve for urine neutrophil gelatinase-associated lipocalin (uNGAL) (AUC=0.780; 95% CI, 0.423-0.936). By using a cutoff value of 10.3 ng/mL for the diagnosis of UTI, sensitivity and specificity were 70% and 70%, respectively (red dot).

• 

  Fig. 3 ROC curves to detect urinary tract infection (UTI) defined by the presence or absence of leukocyte esterase. The blue line is ROC curve for serum neutrophil gelatinase-associated lipocalin (sNGAL) (area under the curve [AUC]=0.654; 95% CI, 0.397-0.922). By using a cutoff value of 75.05 ng/mL for the diagnosis of UTI, sensitivity and specificity were 70% and 49%, respectively (blue dot). The red line is ROC curve for urine neutrophil gelatinase-associated lipocalin (uNGAL) (AUC=0.761; 95% CI, 0.435-0.977). By using a cutoff value of 9.65 ng/mL for the diagnosis of UTI, sensitivity and specificity were 70% and 68%, respectively (red dot).

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