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Elevated urine levels of heparin-binding protein in children with urinary tract infection

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Abstract

Background

Urinary tract infection (UTI) is a common infection diagnosis in children, and efficient diagnosis and treatment are important to avoid serious complications. In this study we investigated whether urinary levels of neutrophil-derived heparin-binding protein (HBP) can be used as a marker of UTI in children. These results were compared to those of dipstick analysis, interleukin-6 (IL-6) analysis in urine, and bacterial culturing.

Methods

Seventy-eight children aged 0–18 years with fever and/or symptoms indicating UTI were enrolled in a prospective consecutive study. Urine samples were cultured and analyzed with dipstick, and concentrations of HBP and IL-6 were measured.

Results

Fifteen patients were classified as having UTI, 30 patients had fever but were diagnosed with a non-urinary tract infection, and 33 patients had neither UTI nor fever. Using a urine HBP (U-HBP) cut-off level of 32 ng/mL, the sensitivity and specificity for detecting UTI were 93.3 and 90.3 %, respectively. Receiver operating characteristic curves demonstrated that U-HBP levels were a higher specificity indicator of UTI than urine white blood cell counts or urine IL-6 levels; they also showed a higher sensitivity than the results of the urine nitrite test. All patients with significant growth of clinically relevant bacteria had elevated U-HBP levels.

Conclusion

The results indicate that rapid analysis of U-HBP can provide helpful guidance in the management of children with suspected UTI.

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Abbreviations

CRP:

C-reactive protein

HBP:

Heparin-binding protein

IL-6:

Interleukin-6

UTI:

Urinary tract infection

U-WBC:

Urinary white blood cell count

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Acknowledgments

The authors thank the staff of the Department of Pediatric Diseases, the Hospital of Helsingborg for excellent assistance in the process of including patients in the study, and D. Nelson for statistical support. This project was supported in part by the Swedish Research Council, Stockholm, Sweden (project 7480 and 13,413), the Royal Physiographic Society, Lund, the Swedish Government Funds for Clinical Research (ALF), Hansa Medical AB, Lund, Sweden, and the Foundations of Greta and Johan Kock, Alfed Österlund, and Torsten and Ragnar Söderberg.

Transparency declaration

Potential conflicts of interests. Hansa Medical AB that in part funded this study has filed a patent application on the use of HBP as a diagnostic tool for urinary tract infection. A. Linder and P. Åkesson are listed as inventors. The patent application is pending.

Author contributions

Concept and design: P. Åkesson and A. Linder. Data analysis and laboratory analyses: C. Kjölvmark and A. Linder. Writing of the manuscript: C. Kjölvmark. Provision of study material and patients: C. Kjölvmark. Critical revision and important intellectual advice: P. Åkesson and A. Linder.

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Authors and Affiliations

  1. Division of Infection Medicine, Hospital of Helsingborg, 221 85, Lund, Sweden

    Charlott Kjölvmark

  2. Department of Clinical Sciences, Division of Infection Medicine, Lund University Hospital, 221 85, Lund, Sweden

    Per Åkesson & Adam Linder

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  1. Charlott Kjölvmark
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  2. Per Åkesson
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  3. Adam Linder
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Correspondence to Adam Linder.

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Kjölvmark, C., Åkesson, P. & Linder, A. Elevated urine levels of heparin-binding protein in children with urinary tract infection. Pediatr Nephrol 27, 1301–1308 (2012). https://doi.org/10.1007/s00467-012-2132-x

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  • DOI: https://doi.org/10.1007/s00467-012-2132-x

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