Urinary neutrophil gelatinase-associated lipocalin: potential biomarker for late-onset sepsis.

Abstract

BACKGROUND:

To assess the ability of urinary neutrophil gelatinase-associated lipocalin (UNGAL) to discriminate between culture-positive vs. culture-negative late-onset sepsis evaluations.

METHODS:

This is a prospective observational study of 136 neonates who underwent ≥1 sepsis evaluation at >72 h of age. Urine was obtained at the time of sepsis evaluation to measure UNGAL concentration. Using generalized estimating equations controlling for gender, gestational and postnatal age, acute kidney injury, and within-patient correlations, pair-wise contrasts between mean log UNGAL concentrations of infants with negative sepsis evaluations vs. culture-positive sepsis and presumed sepsis were assessed. Discrimination characteristics at several UNGAL cutoff concentrations were assessed using receiver-operating characteristic curves.

RESULTS:

The predicted mean log UNGAL values of culture-positive sepsis and presumed sepsis vs. negative sepsis evaluations differed significantly (P < 0.001 and P = 0.02, respectively). At a cutoff ≥ 50 ng/ml, UNGAL discriminated between culture-positive sepsis and culture-negative sepsis evaluations with sensitivity = 86%, specificity = 56%, positive predictive value = 41%, negative predictive value = 92%, and number needed to treat = 3.

CONCLUSION:

UNGAL is a noninvasive biomarker with high negative predictive value at the time of late-onset sepsis evaluation in neonates and could be a useful adjunct to traditional components of sepsis evaluations.

• Authors: Jennifer M Pynn, Elvira Parravicini, Lisa Saiman, David A Bateman, Jonathan M Barasch, John M Lorenz
• Journal: Pediatric research (Pediatr Res) Vol. 78 Issue 1 Pg. 76-81 (Jul 2015) ISSN: 1530-0447 [Electronic] United States
• PMID: 25806716 (Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural)

Chemical References

• Acute-Phase Proteins
• Biomarkers
• LCN2 protein, human
• Lipocalin-2
• Lipocalins
• Proto-Oncogene Proteins

Topics

• Acute Kidney Injury (physiopathology)
• Acute-Phase Proteins (urine)
• Biomarkers (urine)
• Female
• Gestational Age
• Hospitalization
• Humans
• Infant, Newborn
• Intensive Care, Neonatal
• Lipocalin-2
• Lipocalins (urine)
• Male
• Predictive Value of Tests
• Prospective Studies
• Proto-Oncogene Proteins (urine)
• ROC Curve
• Sensitivity and Specificity
• Sepsis (diagnosis, urine)