title: Plasma neutrophil gelatinase-associated lipocalin: a marker of acute pyelonephritis in children.
abstract: This study was designed to compare the diagnostic accuracy of plasma neutrophil gelatinase-associated lipocalin (NGAL) with procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBCs) for predicting acute pyelonephritis (APN) in children with febrile urinary tract infections (UTIs).
  
  
  
  In total, 138 children with febrile UTIs (APN 59, lower UTI 79) were reviewed retrospectively. Levels of NGAL, PCT, CRP, and WBCs in blood were measured on admission. The diagnostic accuracy of the biomarkers was investigated. Independent predictors of APN were identified by multivariate logistic regression analysis.
  
  
  
  Receiver operating curve (ROC) analyses showed good diagnostic profiles of NGAL, PCT, CRP, and WBCs for identifying APN [area under the curve (AUC) 0.893, 0.855, 0.879, and 0.654, respectively]. However, multivariate analysis revealed only plasma NGAL level was an independent predictor of APN (P = 0.006). At the best cutoff values of all examined biomarkers for identifying APN, sensitivity (86 %), specificity (85 %), positive predictive value (81 %), and negative predictive value (89 %) of plasma NGAL levels were the highest. The optimal NGAL cutoff value was 117 ng/ml. The positive likelihood ratio [odds ratio (OR) 5.69, 95 % confidence interval (CI) 3.56-8.78], and negative likelihood ratio (OR 0.16, 95 % CI 0.08-0.29) of plasma NGAL for APN diagnosis also showed it seemed to be more accurate than serum PCT, CRP, and WBCs.
  
  
  
  Plasma NGAL can be more useful than serum PCT, CRP, and WBC levels for identifying APN in children with febrile UTIs.
authors.affiliation: Department of Pediatrics, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
authors.forename: Byung Kwan
authors.initials: BK
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, South Korea. he-yim@hanmail.net.
authors.forename: Hyung Eun
authors.identifier: 0000-0001-9805-9278
authors.initials: HE
authors.lastname: Yim
authors.affiliation: Department of Pediatrics, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
authors.forename: Kee Hwan
authors.initials: KH
authors.lastname: Yoo
mesh_terms: D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000097:blood / Q000175:diagnosis; D007223:Infant; D007231:Infant, Newborn; D007958:Leukocyte Count; D000071068:Lipocalin-2 / Q000097:blood*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011704:Pyelonephritis / Q000097:blood* / Q000175:diagnosis*; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000097:blood / Q000175:diagnosis; D014718:Vesico-Ureteral Reflux / Q000097:blood / Q000175:diagnosis
chemical_list: D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D002116:Calcitonin; D002097:C-Reactive Protein
keywords: Acute pyelonephritis; Biomarkers; Children; Neutrophil gelatinase-associated lipocalin; Urinary tract infection