title: 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.
  
  
  CONCLUSIONS
  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: Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, New York.
authors: Jennifer M
authors: JM
authors: Pynn
authors: Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York.
authors: Elvira
authors: E
authors: Parravicini
authors: Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York.
authors: Lisa
authors: L
authors: Saiman
authors: Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York.
authors: David A
authors: DA
authors: Bateman
authors: Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York.
authors: Jonathan M
authors: JM
authors: Barasch
authors: Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York.
authors: John M
authors: JM
authors: Lorenz
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology; D000209:Acute-Phase Proteins / Q000652:urine*; D015415:Biomarkers / Q000652:urine*; D005260:Female; D005865:Gestational Age; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis / Q000652:urine*
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins