180 - Biomarkers for Febrile Urinary Tract Infection in Children

Poster Number: 180
Publication Number: 180.317

Vinod Rajakumar, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Nader Shaikh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Marcia Kurs-Lasky, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, Pittsburgh, PA, United States; Sojin Lee, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Background: The current reference standard for pediatric urinary tract infection (UTI) screening in the emergency department (ED) is the leukocyte esterase (LE) dipstick test. The sensitivity and specificity of the LE test for the diagnosis of UTI is suboptimal with a sensitivity and specificity of 79% and 87%, respectively [Williams GJ].

Objective: The objective of this study was to compare the accuracy of novel urinary biomarkers to that of available markers (LE).

Design/Methods: 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 accuracy of available markers (LE).

Results: We included 374 children (50 with UTI, 324 without UTI) and examined 35 urinary biomarkers. Urinary biomarkers that best discriminated between febrile children with and without UTI were NGAL, a protein that exerts a local bacteriorstatic role in the urinary tract through iron chelation, IL-1-beta, a pro-inflammatory biomarker that serves to recruit neutrophils and other leukocytes, and CXCL1 and IL-8, both of which act as chemoattractants that play a role in neutrophil recruitment. NGAL had the highest accuracy out of all examined urinary biomarkers. Our analysis revealed a sensitivity and specificity of 90.0% and 95.6% for NGAL, compared to a sensitivity and specificity of 88.0% and 96.3% for LE.Conclusion(s): Use of NGAL as a screening test for UTI in the ED setting has the potential to reduce missed diagnosis of UTI as well as reducing overtreatment. Limitations with using NGAL over LE include increased cost and lower specificity; further investigation is warranted to determine the cost-effectiveness of using NGAL as a screening test for UTI.