Early
diagnosis of urinary tract infection (UTI) in pediatric patients is a prob-lem
due to the absence of specific symptoms and difficulty in obtaining the proper
urine sample. These difficulties increase the need for effective biomarker for
UTI diagnosis in young patients. Neutrophil gelatinase-associated lipocalin
(NGAL) is proved to be a marker for UTI diagnosis. YKL-40 is a glycosyl
hydrolase which is produced locally at the sites of inflammation. The objective
of our study is to assess the value of YKL-40 as a possible marker for UTI
diagnosis in febrile children and to compare its value versus NGAL. Urine
culture was used as a gold standard for UTI diagnosis. The study enrolled three
groups; febrile children with positive urine culture, febrile children with
negative urine culture, and controls without fever and with negative urine
culture. Each group included 50 children from patients attended outpatients
clinics department of Mansoura University Children Hospital. For each patient
enrolled in the study, complete blood count, C-reactive protein, serum
creatinine, urine creatinine, routine urine analysis and urine culture were
assessed. Using ELISA test, urine values of NGAL (uNGAL) and YKL-40 (uYKL-40)
were measured and normalized to urine creatinine (uNGAL/uCr) and (uYKL40/uCr)
respectively. The values of uNGAL, uYKL-40, uNGAL/Cr and uYKL-40/Cr were significantly
higher in febrile UTI group. The receiver operating curve (ROC) show the
optimum cut off value for urine YKL-40 (171.5 pg) with 84% senstivity, 82%
specificity and the area under the ROC curve (AUC) 0.95. The optimum cutoff
value of uYKL-40/Cr was (159.2 pg/mg) with 72% sensitivity, 71% specificity and
0.81 AUC. Higher sensitivity and specificity of uYKL-40 and uYKL40/Cr compared
to uNGAL and uNGAL/Cr respectively were observed. In conclusion, the diagnostic
value of uYKL-40 is superior to that of uNGAL. Urine YKL-40 could be a good
marker for diagnosis of UTI in febrile pediatric patients.
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