Shaikh Nader, Kurs-Lasky Marcia, Liu Hui, Rajakumar Vinod, Qureini Heba, Conway Isabella O, Lee Matthew C, Lee Sojin
Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Front Pediatr. 2023 May 9;11:1163546. doi: 10.3389/fped.2023.1163546. eCollection 2023.
The current reference standard for pediatric urinary tract infection (UTI) screening, the leukocyte esterase (LE) dipstick test, has suboptimal accuracy. The objective of this study was to compare the accuracy of novel urinary biomarkers to that of the LE test.
We prospectively enrolled febrile children who were evaluated for UTI based on their presenting symptoms. We compared the accuracy of urinary biomarkers to that of the test.
We included 374 children (50 with UTI, 324 without UTI, ages 1-35 months) and examined 35 urinary biomarkers. The urinary biomarkers that best discriminated between febrile children with and without UTI were urinary neutrophil gelatinase-associated lipocalin (NGAL), IL-1β, CXCL1, and IL-8. Of all examined urinary biomarkers, the urinary NGAL had the highest accuracy with a sensitivity of 90% (CI: 82-98) and a specificity of 96% (CI: 93-98).
Because the sensitivity of the urinary NGAL test is slightly higher than that of the LE test, it can potentially reduce missed UTI cases. Limitations of using urinary NGAL over LE include increased cost and complexity. Further investigation is warranted to determine the cost-effectiveness of urinary NGAL as a screening test for UTI.
目前用于小儿尿路感染（UTI）筛查的参考标准——白细胞酯酶（LE）试纸条检测，其准确性欠佳。本研究的目的是比较新型尿液生物标志物与LE检测的准确性。
我们前瞻性纳入了因出现相关症状而接受UTI评估的发热儿童。我们将尿液生物标志物的准确性与该检测的准确性进行了比较。
我们纳入了374名儿童（50名患有UTI，324名未患UTI，年龄1至35个月），并检测了35种尿液生物标志物。在区分发热的UTI患儿和非UTI患儿方面表现最佳的尿液生物标志物是尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、白细胞介素-1β（IL-1β）、CXC趋化因子配体1（CXCL1）和白细胞介素-8（IL-8）。在所有检测的尿液生物标志物中，尿NGAL的准确性最高，敏感性为90%（可信区间：82%-98%），特异性为96%（可信区间：93%-98%）。
由于尿NGAL检测的敏感性略高于LE检测，它有可能减少UTI漏诊病例。与LE检测相比，使用尿NGAL检测的局限性包括成本增加和操作复杂性提高。有必要进一步研究以确定尿NGAL作为UTI筛查检测的成本效益。
