title: Glucosuria as an early marker of late-onset sepsis in preterms: a prospective cohort study.
abstract: BACKGROUND
  Early and accurate diagnosis of late-onset sepsis (LONS) in preterm infants is difficult since presenting signs are subtle and non-specific. Because neonatal sepsis may be accompanied by glucose intolerance and glucosuria, we hypothesized that glucosuria may be associated with LONS in preterms, in an early stage. We aim to evaluate the association of glucosuria and late-onset neonatal sepsis (LONS) in preterm infants, in an attempt to improve early and accurate diagnosis of LONS.
  
  
  METHODS
  We performed a prospective observational cohort study in 316 preterms (<34 weeks). We daily measured glucosuria and followed patients for occurrence of LONS, defined as clinical and blood culture-proven sepsis occurring after 72 h. Attending physicians were blinded to glucosuria results. We assessed the diagnostic value of glucosuria for clinical and blood culture-proven LONS using logistic regression analysis.
  
  
  RESULTS
  Glucosuria was found in 65.8% of 316 preterm patients, and sepsis was suspected 157 times in 123 patients. LONS was found in 47.1% of 157 suspected episodes. The presence of glucosuria was associated with LONS (OR 2.59, 95% CI 1.24-5.43, p = 0.012) with sensitivity 69.0% and specificity 53.8% (Likelihoodratio 1.49). After adjustment for gestational age, birth weight, and postnatal age, this association weakened and was no longer significant (adjusted OR 2.16; 95% CI 0.99-1.85, p = 0.055). An increase in glucosuria 48-24 h before onset of symptoms was not associated with LONS.
  
  
  CONCLUSIONS
  In preterms glucosuria is associated with LONS within 24 h, however this association is too weak to be of diagnostic value.
authors.affiliation: Princess Amalia Children's Clinic, Isala, Dr van Heesweg 2, PO Box 10400, 8000 GK, Zwolle, The Netherlands. j.bekhof@isala.nl.
authors.forename: Jolita
authors.initials: J
authors.lastname: Bekhof
authors.affiliation: Department of General Practice, University MedicalCenter Groningen, University of Groningen, Groningen, The Netherlands. b.j.kollen@med.umcg.nl.
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Kollen
authors.affiliation: Department of Neonatology, Academic Medical Center, Amsterdam, The Netherlands. j.h.kok@amc.uva.nl.
authors.forename: Joke H
authors.initials: JH
authors.lastname: Kok
authors.affiliation: Princess Amalia Children's Clinic, Isala, Dr van Heesweg 2, PO Box 10400, 8000 GK, Zwolle, The Netherlands. h.l.m.van.straaten@isala.nl.
authors.forename: Henrica L M
authors.initials: HL
authors.lastname: Van Straaten
mesh_terms: D015415:Biomarkers / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000652:urine*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000652:urine*; D019102:Infant, Very Low Birth Weight; D008297:Male; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000175:diagnosis / Q000652:urine*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D005947:Glucose