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Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders

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Abstract

Background

Distinguishing between urinary tract infection (UTI) and colonization (UTC) in patients with neurogenic bladders who require clean intermittent catheterization (CIC) is difficult. Urinary neutrophil gelatinase-associated lipocalin concentrations (uNGAL) are increased in UTIs. Our objective was to determine the predictive accuracy of uNGAL for UTI in CIC-dependent children.

Methods

Cross-sectional study of CIC-dependent patients from August, 2015 to November, 2016. UTI was defined as (1) growth of ≥ 50,000 cfu/mL of a uropathogen, (2) > 10 urinary white blood cells/hpf, and (3) ≥ 2 of the following: temperature > 38 °C, abdominal pain, back pain, worsened incontinence, pain with catheterization, or malodorous/cloudy urine. Positive urine cultures that did not meet these criteria were grouped as UTC, and negative cultures were grouped as no growth.

Results

Two hundred one patients were included (no growth = 100, UTC = 77, UTI = 24). Median (interquartile range) uNGAL was higher in the UTI group (UTI 1361 (931, 2516) μg/g creatinine, UTC 246 (106, 548) μg/g creatinine, no growth 36 (11, 179) μg/g creatinine, p < 0.01 for all comparisons). The area under the ROC curve for uNGAL for UTI versus no UTI was 0.89, 95% CI (0.80–0.98).

Conclusion

uNGAL is elevated in CIC-dependent children with UTI compared to those with negative cultures and those with UTC.

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Acknowledgements

We are grateful for the assistance of both Tara Terrell, MS, and Theresa Mottes, MSN, RN, from the Center for Acute Care Nephrology at Cincinnati Children’s Hospital Medical Center, for their assistance with sample collection. Tara Terrell does not have any conflicts of interest, industry relationships, or funding sources to report. Theresa Mottes is on the speaker’s bureau for Baxter.

Funding

CF received research training support from the National Institutes of Health through a National Research Service Award Institutional Training Grant, T32 HRSA 09-046 CFDA No. 93.186.

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Authors and Affiliations

  1. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA

    Catherine S. Forster, Qing Ma, Michael Bennett, Samir S. Shah & Stuart L. Goldstein

  2. Department of Pediatrics and Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 42559, USA

    Elizabeth Jackson

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  1. Catherine S. Forster
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  2. Elizabeth Jackson
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Corresponding author

Correspondence to Catherine S. Forster.

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Conflicts of interest

Stuart Goldstein receives consulting fees and grant funding from Bioporto, Inc., which owns an assay for NGAL. No support from Bioporto, Inc., was used for the work reported in this manuscript.

The remainder of the authors do not have any conflicts of interest to disclose.

The study was approved by the Cincinnati Children’s Hospital Medical Center Institutional Review Board with a waiver of informed consent as the urine samples were discarded specimens.

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Forster, C.S., Jackson, E., Ma, Q. et al. Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders. Pediatr Nephrol 33, 1365–1374 (2018). https://doi.org/10.1007/s00467-018-3936-0

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  • DOI: https://doi.org/10.1007/s00467-018-3936-0

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