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Title: | Urinary HSP70 improves diagnostic accuracy for urinary tract infection in children: UTILISE study [Article] | Authors: | Yilmaz A. Afonso A.C. Akil I. Aksu B. Alpay H. Atmis B. Aydog O. Yüksel, Selçuk Bayram, Meral Torun Bilge, Ilmay Bulut, Ipek Kaplan Buyukkaragoz, Bahar Comak, Elif Demir, Belde Kasap Dincel, Nida Donmez, Osman Durmus, Mehmet Akif Duzova, Ali Ertan, Pelin Gedikbasi, Asuman Goknar, Nilufer Guven, Sercin Hacihamdioglu, Duygu Jankauskiene, Augustina Kalyoncu, Mukaddes Kenan, Bahriye Uzun Kucuk, Nuran Kural, Bahar Montini, Giovanni Morello, William Nayir, Ahmet Obrycki, Lukasz Omer, Beyhan Ozdemir, Ebru Misirli Ozkayin, Nese Paripovic, Dusan Pehlivanoglu, Cemile Saygili, Seha Schaefer, Susanne Sonmez, Ferah Tabel, Yilmaz Tas, Nesrin Tasdemir, Mehmet Teixeira, Ana Tekcan, Demet Tulpar, Sebahat Turkkan, Ozde Nisa Uysal, Berfin Uysalol, Metin Vaiciuniene, Daiva Yavuz, Sevgi Yel, Sibel Yildirim, Tarik Yildirim, Zeynep Yuruk Yildiz, Nurdan Yurtseven, Eray Topaloglu, Rezan Schaefer, Franz Bayazit, Aysun Karabay Litwin, Mieczyslaw |
Keywords: | Children Heat shock proteins HSP70 Urinary tract infection UTI |
Publisher: | Springer Science and Business Media Deutschland GmbH | Abstract: | Background: The accuracy of conventional urinalysis in diagnosing urinary tract infection (UTI) in children is limited, leading to unnecessary antibiotic exposure in a large fraction of patients. Urinary heat shock protein 70 (uHSP70) is a novel marker of acute urinary tract inflammation. We explored the added value of uHSP70 in discriminating UTI from other infections and conditions confused with UTI. Methods: A total of 802 children from 37 pediatric centers in seven countries participated in the study. Patients diagnosed with UTI (n = 191), non-UTI infections (n = 178), contaminated urine samples (n = 50), asymptomatic bacteriuria (n = 26), and healthy controls (n = 75) were enrolled. Urine and serum levels of HSP70 were measured at presentation in all patients and after resolution of the infection in patients with confirmed UTI. Results: Urinary (u)HSP70 was selectively elevated in children with UTI as compared to all other conditions (p < 0.0001). uHSP70 predicted UTI with 89% sensitivity and 82% specificity (AUC = 0.934). Among the 265 patients with suspected UTI, the uHSP70 > 48 ng/mL criterion identified the 172 children with subsequently confirmed UTI with 90% sensitivity and 82% specificity (AUC = 0.862), exceeding the individual diagnostic accuracy of leukocyturia, nitrite, and leukocyte esterase positivity. uHSP70 had completely normalized by the end of antibiotic therapy in the UTI patients. Serum HSP70 was not predictive. Conclusions: Urine HSP70 is a novel non-invasive marker of UTI that improves the diagnostic accuracy of conventional urinalysis. We estimate that rapid urine HSP70 screening could spare empiric antibiotic administration in up to 80% of children with suspected UTI. Graphical abstract: A higher resolution version of the Graphical abstract is available as Supplementary information [Figure not available: see fulltext.] © 2022, The Author(s), under exclusive licence to International Pediatric Nephrology Association. | URI: | https://doi.org/10.1007/s00467-022-05664-5 https://hdl.handle.net/11499/47359 |
ISSN: | 0931-041X |
Appears in Collections: | PubMed İndeksli Yayınlar Koleksiyonu / PubMed Indexed Publications Collection Scopus İndeksli Yayınlar Koleksiyonu / Scopus Indexed Publications Collection Tıp Fakültesi Koleksiyonu WoS İndeksli Yayınlar Koleksiyonu / WoS Indexed Publications Collection |
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