title: Neutrophil Gelatinase-Associated Lipocalin Biomarker and Urinary Tract Infections: A Diagnostic Case-Control Study (NUTI Study).
abstract: Acute uncomplicated urinary tract infection (UTI) in women is often treated based on symptoms alone. Urinary tract infection symptoms are highly sensitive but lack specificity and result in overuse of antibiotics. We sought to determine if urine neutrophil gelatinase-associated lipocalin (uNGAL) levels in urine can accurately discriminate between UTI and healthy women.
  
  
  
  We recruited adult women aged 18 to 85 years presenting in the ambulatory setting from November 2014 to January 2016. Cases were defined as women with Centers for Disease Control and Prevention-defined UTI symptoms and a positive urine culture of more than 10 organisms/mL on a midstream clean-catch specimen. Women without UTI symptoms were matched by age and menopausal status as control subjects. Exclusion criteria were no UTIs within 8 weeks, urinary tract anomalies, renal disease, pregnancy, or diabetes. Clean-catch urine samples were obtained for measuring uNGAL, prior to antibiotic treatment of cases. We used Mann-Whitney U test to compare the 2 groups. Receiver operating characteristic curves were plotted to compare the performance of uNGAL to established urinary markers.
  
  
  
  We enrolled 50 UTI cases and 50 control subjects. Urine NGAL levels were higher in the UTI group than in the control subjects (P < 0.0001). Using a cutoff of 23.9 ng/mL, NGAL achieved 98% sensitivity and 100% specificity. The receiver operating characteristic curve had an area under the curve of 0.97 (95% confidence interval, 0.93-1.00), which was significantly high and showed that uNGAL can identify UTI.
  
  
  
  Urine NGAL has the potential as a biomarker for diagnosing UTIs in adult women.
authors.affiliation: From the *Division of Urogynecology, Obstetrics and Gynecology Department, †School of Medicine, ‡Department of Biostatistics, and §Obstetrics and Gynecology Department, Oregon Health & Science University, Portland, OR.
authors.forename: Jameca Renee
authors.initials: JR
authors.lastname: Price
authors.forename: Larissa
authors.initials: L
authors.lastname: Guran
authors.forename: Jeong Youn
authors.initials: JY
authors.lastname: Lim
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Megli
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Clark
authors.forename: Sharon Renee
authors.initials: SR
authors.lastname: Edwards
authors.forename: Mary Anna
authors.initials: MA
authors.lastname: Denman
authors.forename: W Thomas
authors.initials: WT
authors.lastname: Gregory
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D000071068:Lipocalin-2 / Q000378:metabolism*; D008875:Middle Aged; D012372:ROC Curve; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000652:urine; D055815:Young Adult
chemical_list: D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2