Background

The sensitivity and specificity of the leukocyte esterase test are relatively low for a screening test for urinary tract infection (UTI). More accurate tests could reduce both overtreatment and missed cases. This study aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL) can replace leukocyte esterase in the diagnosis of UTI and/or whether NGAL accurately identifies children with acute pyelonephritis.

Methods

Data sources—MEDLINE and EMBASE. We only considered published studies that evaluated the results of an index test (NGAL) against the results of urine culture (for UTI) or against the results of dimercaptosuccinic acid (for acute pyelonephritis) in children aged 0 to 18 years. Two authors independently applied the selection criteria to all citations and independently extracted the data.

Results

A total of 12 studies met our inclusion criteria. Four studies (920 children) included data on NGAL for UTI; eight studies (580 children) included data on NGAL for pyelonephritis. We did not pool accuracy values because the included studies used different cutoff values. For the diagnosis of UTI, urinary NGAL appeared to have better accuracy than the leukocyte esterase test in all included studies. For the diagnosis of pyelonephritis, neither plasma NGAL nor urinary NGAL had high sensitivity and/or specificity. The number of studies was the main limitation of this systematic review.

Conclusions

Urinary NGAL appears promising for the diagnosis of UTI; however, larger studies are needed to validate this marker as a replacement for leukocyte esterase. The use of NGAL for diagnosing acute pyelonephritis requires further study.

中文翻译：

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中性粒细胞明胶酶相关脂质运载蛋白治疗尿路感染和肾盂肾炎：系统评价

背景

对于尿路感染 (UTI) 的筛查试验，白细胞酯酶试验的敏感性和特异性相对较低。更准确的测试可以减少过度治疗和漏诊病例。本研究旨在确定中性粒细胞明胶酶相关载脂蛋白 (NGAL) 是否可以替代白细胞酯酶诊断 UTI 和/或 NGAL 是否准确识别患有急性肾盂肾炎的儿童。

方法

数据来源——MEDLINE 和 EMBASE。我们只考虑了已发表的研究，这些研究在 0 至 18 岁儿童中对照尿培养结果（针对 UTI）或二巯基琥珀酸结果（针对急性肾盂肾炎）评估了指数测试 (NGAL) 的结果。两位作者独立地将选择标准应用于所有引文并独立提取数据。

结果

共有 12 项研究符合我们的纳入标准。四项研究（920 名儿童）包括尿路感染的 NGAL 数据；八项研究（580 名儿童）包括关于 NGAL 治疗肾盂肾炎的数据。我们没有汇总准确度值，因为纳入的研究使用了不同的截止值。对于 UTI 的诊断，在所有纳入的研究中，尿 NGAL 似乎比白细胞酯酶测试具有更好的准确性。对于肾盂肾炎的诊断，血浆NGAL和尿NGAL均不具有高敏感性和/或特异性。研究的数量是该系统评价的主要限制。

结论

尿液 NGAL 似乎对 UTI 的诊断很有希望；然而，需要更大规模的研究来验证该标记是否可以替代白细胞酯酶。使用 NGAL 诊断急性肾盂肾炎需要进一步研究。