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Predictive Ability of NGAL in Distinguishing Urinary Tract Infection from Colonization in Children who Require Clean Intermittent Catheterization

Forster, Catherine S.
http://orcid.org/0000-0002-6233-1070
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491558718150357

Abstract Details

2017, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Introduction: Children with neurogenic bladders who require clean intermittent catheterization (CIC) frequently have bacteriuria, although distinguishing between urinary tract infection (UTI) and colonization (UTC) in this population can be difficult. Urinary neutrophil gelatinase-associated lipocalin concentrations (uNGAL) are increased in UTIs. We hypothesize that uNGAL will be higher in patients with UTI compared with both UTC and negative cultures. Objective: Compare uNGAL concentrations between children with neurogenic bladder who require CIC whose urine cultures are grouped as no growth, UTC, or UTI to determine the predictive accuracy of uNGAL for UTI in this population. Methods: Urine samples were obtained from patients requiring CIC who had a urine culture sent for clinical care. UTI was defined as growth of >/= 50,000 colony-forming units/ml of a known uropathogen, >10 urinary white blood cells/high-powered field, and >/= 2 of the following: fever, abdominal pain, back pain, new or worse incontinence, pain with CIC and foul-smelling urine. UTC was defined a positive urine culture that did not meet criteria for UTI. Cultures with growth of mixed organisms or fungi, those without a concurrent urinalysis, and cultures from patients who are dialysis-dependent or with concern for acute kidney injury or sepsis were excluded. uNGAL was measured by ELISA, and urine creatinine by assay. Normally distributed continuous variables were compared by ANOVA; non-normally distributed variables were compared by kruskal-wallis test with post-hoc Dunn. Categorical variables were compared by chi-square. ROC analysis was performed to determine sensitivity and specificity. uNGAL is presented as standardardized by urine creatinine and without standardization. Results: 201 patients were included (no growth=100, UTC=71, UTI=30). Patients in the UTC group were older and had a higher proportion of females than the no growth group. Median uNGAL was higher in the UTI group compared with other groups (uNGAL/cr: 1127 (665, 2158) ug/gm creatinine for UTI, 259 (103, 617)ug/gm creatinine for UTC, 36 (11, 179) ug/gm creatinine for no growth, p<0.01 for all comparisons. Non-normalized uNGAL: 402 (176,928) ng/mL for UTI, 134 (49, 225) ng/mL for UTC, 18 (5, 78) ng/mL for no growth, p<0.01 for all comparisons). The AUC for normalized uNGAL for UTI versus no UTI was 0.86, 95% CI(0.78-0.94), and non-normalized NGAL was 0.85 95% CI(0.77-0.92). At a cut-off of 802 ug/gm crt, normalized uNGAL has a sensitivity of 77% and a specificity of 89% for UTI, whereas non-normalized NGAL has a sensitivity of 93% and specificity of 65% at a cut-off of 107 ng/mL. Conclusion: uNGAL is elevated in children who require CIC who have UTI compared with those with negative cultures or UTC. uNGAL concentrations may provide actionable data to inform earlier treatment decisions about UTIs in this unique population.
Erin Haynes, Dr.P.H. (Committee Chair)
Stuart Goldstein, M.D. (Committee Member)
Heidi Sucharew, Ph.D. (Committee Member)
19 p.
Surgery
Urinary Tract Infections; Neurogenic Bladders; Biomarker

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Citations

  • Forster, C. S. (2017). Predictive Ability of NGAL in Distinguishing Urinary Tract Infection from Colonization in Children who Require Clean Intermittent Catheterization [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491558718150357

    APA Style (7th edition)

  • Forster, Catherine. Predictive Ability of NGAL in Distinguishing Urinary Tract Infection from Colonization in Children who Require Clean Intermittent Catheterization. 2017. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491558718150357.

    MLA Style (8th edition)

  • Forster, Catherine. "Predictive Ability of NGAL in Distinguishing Urinary Tract Infection from Colonization in Children who Require Clean Intermittent Catheterization." Master's thesis, University of Cincinnati, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491558718150357

    Chicago Manual of Style (17th edition)

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