Ann Lab Med.  2018 Sep;38(5):425-430. 10.3343/alm.2018.38.5.425.

Plasma Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Renal Parenchymal Involvement in Infants With Febrile Urinary Tract Infection: A Preliminary Study

• Yun BA
• Yang EM
• Kim CJ

• KMID: 2434731
• DOI: http://doi.org/10.3343/alm.2018.38.5.425

Abstract

BACKGROUND
Urinary tract infection (UTI) is the most common bacterial infection in infants. Renal parenchymal involvement is an important prognostic factor; however, early detection of parenchymal involvement in UTI may be difficult during infancy. This study aimed to assess whether a recently established biomarker of UTI, neutrophil gelatinase-associated lipocalin (NGAL), can serve as a useful marker for the detection of cortical defects (CD) and to determine the appropriate diagnostic cut-off value of NGAL in infants with febrile UTI.
METHODS
Infants hospitalized for febrile UTI were divided into two groups according to the presence of cortical defects on dimercaptosuccinic acid (DMSA) scintigraphy. Among 64 enrolled infants, 43 (67%) had CD (UTI-CD) and 21 (33%) had no CD (UTI-ND). The white blood cell count, C-reactive protein, and plasma NGAL (pNGAL) levels were determined before antibiotic therapy and compared between the two groups.
RESULTS
pNGAL level was significantly higher in the UTI-CD group than in the UTI-ND group (340 µg/L vs 214 µg/L, P=0.002). Multivariate analysis showed that pNGAL level was the only independent predictor of CD (odds ratio 2.759, P=0.039). In the ROC curve analysis, pNGAL showed the highest area under the curve (0.745; 95% confidence interval, 0.561-0.821; P=0.014). The appropriate cut-off value of pNGAL was 267 µg/L (sensitivity, 72.1%; specificity, 71.4%).
CONCLUSIONS
pNGAL was found to be a useful marker for early prediction of renal parenchymal involvement in infants with febrile UTI.

Keyword

Neutrophil gelatinase-associated lipocalin; Urinary tract infection; Cortical defect; Infant

MeSH Terms

Bacterial Infections
C-Reactive Protein
Humans
Infant*
Leukocyte Count
Lipocalins*
Multivariate Analysis
Neutrophils*
Plasma*
Radionuclide Imaging
ROC Curve
Sensitivity and Specificity
Succimer
Urinary Tract Infections*
Urinary Tract*
C-Reactive Protein
Lipocalins
Succimer

Figure

• 

  Fig. 1 ROC curve analysis for the detection of cortical defects in infants with febrile urinary tract infection.*The cut-off point selection in the context of ROC curve analysis is the maximum of the Youden index with the level of confidence set at 95%; †Two-by-two tables were used to calculate sensitivity, specificity, PPV, and NPV for cut-off value of variables and the level of confidence set at 95%.Abbreviations: WBC, white blood cells; CRP, C-reactive protein; pNGAL, plasma neutrophil gelatinase-associated lipocalin; AUC, area under curve; CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value.

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