Novel urine biomarkers to distinguish UTI from culture-negative pyuria

Authors

Elaise B. Hill, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA. ehill2@childrensnational.org.
Joshua R. Watson, Division of Infectious Diseases, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
Daniel M. Cohen, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
David Kline, Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA.
Andrew L. Schwaderer, Division of Nephrology, Riley Children's Health, Indiana University School of Medicine, Indianapolis, IN, USA.
John D. Spencer, Division of Nephrology and Hypertension, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.

Document Type

Journal Article

Publication Date

2-1-2022

Journal

Pediatric nephrology (Berlin, Germany)

Volume

37

Issue

2

DOI

10.1007/s00467-021-05202-9

Keywords

Biomarker; Emergency; Pyuria; UTI

Abstract

BACKGROUND: Emergency departments (EDs) often rely on urinalysis (UA) to rapidly identify urinary tract infections (UTIs) in children. However, the suboptimal test characteristics of UA can lead to false-positive results. Novel urinary biomarkers may increase the diagnostic precision of UA. In this study, we compared the concentrations of 6 pre-selected proteins: BH3 interacting domain death agonist (BID), B-cell lymphoma 6 protein, ras GTPase-activating protein 1, cathepsin S (CTSS), 3-hydroxyanthranilate 3,4-dioxygenase, and transgelin-2. METHODS: In a pediatric ED, we prospectively enrolled 167 children with UA and urine culture collected. Pyuria was defined as either ≥ 5 white blood cells per high-power field on microscopy or positive leukocyte esterase (LE). The urine culture was considered positive if it yielded ≥ 50,000 colony-forming units per milliliter of any single urinary pathogen. Urine protein levels were measured by enzyme-linked immunosorbent assay and normalized to urine creatinine. RESULTS: BID was significantly higher in the UTI group compared to the culture-negative pyuria group with a mean ratio of 1.42 (95% confidence interval (CI), 1.15, 1.76) when uncorrected for creatinine concentration. When corrected for creatinine concentration, CTSS was significantly elevated in the UTI group compared to the culture-negative pyuria group with a mean ratio of 2.11 (95% CI, 1.39, 3.21). CONCLUSIONS: BID and CTSS concentrations were elevated in the urine of children with UTI compared to those with culture-negative pyuria. These proteins deserve further research into their utility to serve as novel biomarkers for UTI.

APA Citation

Hill, Elaise B.; Watson, Joshua R.; Cohen, Daniel M.; Kline, David; Schwaderer, Andrew L.; and Spencer, John D., "Novel urine biomarkers to distinguish UTI from culture-negative pyuria" (2022). GW Authored Works. Paper 387.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/387

Department

Pediatrics