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- Title
Novel urine biomarkers to distinguish UTI from culture-negative pyuria.
- Authors
Hill, Elaise B; Watson, Joshua R; Cohen, Daniel M; Kline, David; Schwaderer, Andrew L; Spencer, John D
- Abstract
Background: Emergency departments (EDs) often rely on urinalysis (UA) to rapidly identify urinary tract infections (UTIs) in children. However, the suboptimal test characteristics of UA can lead to false-positive results. Novel urinary biomarkers may increase the diagnostic precision of UA. In this study, we compared the concentrations of 6 pre-selected proteins: BH3 interacting domain death agonist (BID), B-cell lymphoma 6 protein, ras GTPase-activating protein 1, cathepsin S (CTSS), 3-hydroxyanthranilate 3,4-dioxygenase, and transgelin-2. Methods: In a pediatric ED, we prospectively enrolled 167 children with UA and urine culture collected. Pyuria was defined as either ≥ 5 white blood cells per high-power field on microscopy or positive leukocyte esterase (LE). The urine culture was considered positive if it yielded ≥ 50,000 colony-forming units per milliliter of any single urinary pathogen. Urine protein levels were measured by enzyme-linked immunosorbent assay and normalized to urine creatinine. Results: BID was significantly higher in the UTI group compared to the culture-negative pyuria group with a mean ratio of 1.42 (95% confidence interval (CI), 1.15, 1.76) when uncorrected for creatinine concentration. When corrected for creatinine concentration, CTSS was significantly elevated in the UTI group compared to the culture-negative pyuria group with a mean ratio of 2.11 (95% CI, 1.39, 3.21). Conclusions: BID and CTSS concentrations were elevated in the urine of children with UTI compared to those with culture-negative pyuria. These proteins deserve further research into their utility to serve as novel biomarkers for UTI.
- Subjects
URINARY tract infection diagnosis; BIOMARKERS; PROTEINS; HOSPITAL emergency services; CONFIDENCE intervals; URINE; LEUCOCYTES; MICROSCOPY; COLONY-forming units assay; SUPPURATION; CULTURES (Biology); PEDIATRICS; ENZYME-linked immunosorbent assay; DESCRIPTIVE statistics; URINALYSIS; LONGITUDINAL method
- Publication
Pediatric Nephrology, 2022, Vol 37, Issue 2, p385
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-021-05202-9