Urine specific gravity, pyuria, and neutrophil gelatinase-associated lipocalin for identifying urinary tract infection in young children

Kim, Do Young; Yim, Hyung Eun; Son, Min Hwa; Yoo, Kee Hwan

doi:10.1007/s00467-023-05957-3

Cited by 3 publications

(4 citation statements)

References 40 publications

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“…Seven studies were classified as having high risk of applicability concerns ( 36 , 38 – 40 , 43 , 49 , 54 ). Two studies had unclear risk of applicability concern ( 55 , 56 ). Details on the rating of each applicability concern domain are shown in Figure 2 .…”

Section: Resultsmentioning

confidence: 99%

“…The forest plot shown in Figure 3A summarizes the log transformed uNGAL value in each study for the non-UTI samples reported in the pediatric studies. 16 non-UTI groups from 14 studies were included ( 37 , 39 , 40 , 42 , 44 – 48 , 50 , 51 , 53 , 55 , 57 ). Summarized mean and standard deviation were reported.…”

Section: Resultsmentioning

confidence: 99%

“…The estimated area under the curve (AUC) is 0.99. We estimated that the cut-off point of 48.43 ng/ml would optimize Youden Index with sensitivity of 96% and specificity of 97% ( 36 , 37 , 39 , 40 , 42 – 48 , 50 – 53 , 55 , 57 ).…”

Section: Resultsmentioning

confidence: 99%

“…The published literature has identified important advantages to the use of uNGAL as a UTI biomarker over other diagnostic methods. For example, Kim et al studied 218 children with culture-positive UTI and showed that urine specific gravity did not affect the diagnostic performance of uNGAL, and that uNGAL consistently demonstrated higher AUCs compared to pyuria in both dilute and concentrated urine samples ( 55 ). In a prospective study of febrile children being evaluated for UTIs with paired catheterized and bagged urine samples, bagged sample uNGAL had lower quantitative specificities (73.8%) than from catheterized samples (94.3%), although the AUC for the positive diagnosis of UTI was comparable in paired catheterized and bagged urine samples, at 0.96 (95% CI = 0.89–1.00) and 0.93 (95% CI = 0.87–0.99) respectively ( 50 ).…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of diagnostic accuracy of urine neutrophil gelatinase-associated lipocalin in patients with symptoms of urinary tract infections: a meta-analysis

Zhang,

Chen,

Mitsnefes

et al. 2024

Front. Pediatr.

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IntroductionEarly and accurate diagnosis of urinary tract infection (UTI) can prevent serious sequelae including chronic kidney disease. Multiple individual studies have identified urine neutrophil gelatinase-associated lipocalin (uNGAL) as a promising biomarker for early diagnosis of UTI. We sought to understand the distribution and diagnostic accuracy of uNGAL values in patients presenting with UTI symptoms.MethodsOur systematic literature reviews in PubMed, Embase, and Cochrane Reviews up to March 2024, identified 25 studies reporting mean/median, standard deviation/quartiles, and detection limits of uNGAL in symptomatic patients with and without culture-confirmed UTI. Seventeen studies were in children. Meta-analyses were performed using the quantile estimation (QE) method estimating the distributions of uNGAL, which were then compared between the UTI and non-UTI groups for identifying the best cut-off points maximizing the Youden index. Sensitivity analyses were performed on all 25 studies including adult patients.ResultsWe found that uNGAL levels were significantly higher in samples with confirmed UTI compared to those without. In pediatric studies, median and 95% confidence interval (CI) of uNGAL values were 22.41 (95% CI of 9.94, 50.54) ng/mL in non-UTI group vs. 118.85 (95% CI of 43.07, 327.97) ng/mL in UTI group. We estimated the cut-off point of 48.43 ng/mL with highest sensitivity (96%) and specificity (97%) in children. Sensitivity analysis including both pediatric and adult studies yielded similar results.DiscussionThe level of uNGAL in symptomatic patients with confirmed UTI is much higher than that reported in patients without UTI. It may be used as a diagnostic tool to identify UTI early among symptomatic patients. The range of uNGAL concentrations and cut-off points reported in subjects with UTI is much lower than that reported in patients with acute intrinsic kidney injury.Systematic Review Registrationhttps://www.crd.york.ac.uk/, PROSPERO (CRD42023370451).

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