The β-glucosidase assay: a new diagnostic tool for necrotizing enterocolitis. Sensitivity, specificity, and predictive values.
We aimed to establish the utility of serum cytosolic β-glycosidase (CBG) assay as a NEC diagnosis tool. CBG activity has been compared in 192 NEC-free (NEC(-)) and 13 NEC-affected (NEC(+)) neonates, with modified Bell's stages II/III, born at Reina Sofia University Hospital; additional blood hematology, microbiology, and biochemical parameters have been assayed. NEC(+) neonates have higher serum CBG activity, 26.4 ± 12.4 mU/mg; 95 % CI (18.8-33.9), than NEC(-) infants, 11.0 ± 6.6 mU/mg; 95 % CI (10.1-11.9) (p < 0.0001). The CBG cutoff value in the ROC curve, 15.6 mU/mg, discriminates NEC(+)/NEC(-) infants with 84.6 % sensitivity, 85.9 % specificity, 37.9 positive predictive value and 98.2 negative predictive value, 6.11 positive likelihood ratio and 0.18 negative likelihood ratio, 33.61 DOR, and 0.89 AUC. A combined panel [CBG + aspartate aminotransferase + C-reactive protein] shows a 0.90 AUC value in multiple linear regressions.


CONCLUSIONS
The serum CBG level is a good NEC diagnosis test and a novel NEC biomarker which may become a screening tool.


BACKGROUND
•NEC affects ∼2.5 % of infants at NICU, ∼90 % of them weighing <1500 g. •NEC requires a careful differential diagnosis, being lethal if not diagnosed and treated. What is new: •CBG assay will be useful to determine infants without NEC and preventing unnecessary treatment. •CBG assay could discriminate NEC better than other gut-specific sera protein biomarkers.
Experimental Unit. Córdoba Health District. Andalusian Health Service, C/ Isla de Lanzarote s/n Edificio 2, 1ª Planta, 14011, Córdoba, Spain. b22gomoj@uco.es.
José Luis
JL
Gómez-Chaparro Moreno
Department of Epidemiology. Córdoba Health District, Andalusian Health Service, C/ Isla de Lanzarote s/n Edificio 2, 1ª Planta, Córdoba, 14011, Spain.
Alejandro
A
Rodríguez Torronteras
Neonatology Unit, Pediatrics Service, RSUH. Andalusian Health Service, Avda. Menendez Pidal s/n., Córdoba, 14004, Spain.
María Dolores
MD
Ruiz González
Pediatrics Radiology Section, Radiodiagnostic Service, RSUH, Andalusian Health Service, Avda. Menendez Pidal s/n., Córdoba, 14004, Spain.
Lucía
L
Izquierdo Palomares
Department of Biochemistry and Molecular Biology of Córdoba University, Severo Ochoa Building. A4 Highway, Km 396a, Rabanales Campus, Córdoba, 14071, Spain.
Daniel
D
Bonilla Valverde
Department of Biochemistry and Molecular Biology of Córdoba University, Severo Ochoa Building. A4 Highway, Km 396a, Rabanales Campus, Córdoba, 14071, Spain.
Julia
J
Ruiz Laguna
Department of Pediatric of San Pablo-CEU University, School of Medicine. Monteprincipe Campus. Alcorcón, Madrid, 28925, Spain.
Alfonso
A
Delgado Rubio
Department of Biochemistry and Molecular Biology of Córdoba University, Severo Ochoa Building. A4 Highway, Km 396a, Rabanales Campus, Córdoba, 14071, Spain.
Juan
J
López-Barea
D015415:Biomarkers / Q000097:blood; D004796:Clinical Enzyme Tests; D020345:Enterocolitis, Necrotizing / Q000097:blood / Q000175:diagnosis*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D001617:beta-Glucosidase / Q000097:blood*
D015415:Biomarkers; D001617:beta-Glucosidase
Biological markers; Cytosolic beta-glucosidase; Diagnostic; Humans; Necrotizing enterocolitis; Premature infants