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- Title
Urine specific gravity, pyuria, and neutrophil gelatinase-associated lipocalin for identifying urinary tract infection in young children.
- Authors
Kim, Do Young; Yim, Hyung Eun; Son, Min Hwa; Yoo, Kee Hwan
- Abstract
Background: To determine whether urine neutrophil gelatinase-associated lipocalin (uNGAL) might be superior to pyuria for detecting urinary tract infection (UTI) regardless of urine specific gravity (SG) in young children. Methods: We conducted a retrospective analysis of children aged < 3 years who were evaluated for UTI with urinalysis, urine culture, and uNGAL measurements during a 5-year period. Sensitivity, specificity, likelihood ratios (LRs), predictive values (PVs), area under the curves (AUCs) of uNGAL cut-off levels, and various microscopic pyuria thresholds for detecting UTI were calculated for dilute (SG < 1.015) and concentrated urine (SG ≥ 1.015). Results: Of 456 children included, 218 had UTI. The diagnostic value of urine white blood cell (WBC) concentration to define UTI changed with urine SG. For detecting UTI, uNGAL cut-off of 68.4 ng/mL had higher AUC values than pyuria ≥ 5 WBCs/high power field (HPF) for dilute and concentrated urine samples (both P < 0.05). Positive LR and PV and specificity of uNGAL were all greater than those of pyuria ≥ 5 WBCs/HPF regardless of urine SG, although the sensitivity of pyuria ≥ 5 WBCs/HPF was higher than that of uNGAL cut-off for dilute urine (93.8% vs. 83.5%) (P < 0.05). At uNGAL ≥ 68.4 ng/mL and ≥ 5 WBCs/HPF, posttest probabilities of UTI were 68.8% and 57.5% for dilute urine and 73.4% and 57.3% for concentrated urine, respectively. Conclusions: Urine SG can affect the diagnostic performance of pyuria for detecting UTI and uNGAL might be helpful for identifying UTI regardless of urine SG in young children.
- Subjects
SOUTH Korea; URINARY tract infection diagnosis; BIOMARKERS; SPECIFIC gravity; URINE; ACUTE phase proteins; SUPPURATION; RETROSPECTIVE studies; PRE-tests &; post-tests; RESEARCH funding; SENSITIVITY &; specificity (Statistics); RECEIVER operating characteristic curves; URINALYSIS; CARRIER proteins; CHILDREN
- Publication
Pediatric Nephrology, 2023, Vol 38, Issue 10, p3337
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-023-05957-3