International Medicine and Health Guidance News ›› 2022, Vol. 28 ›› Issue (10): 1385-1390.DOI: 10.3760/cma.j.issn.1007-1245.2022.10.013

• Scientific Research • Previous Articles     Next Articles

Urinary neutrophil gelatinase-associated lipocalin as a diagnostic marker for urinary tract infection: a systematic review and meta-analysis

Li Rugang, Huang Jieping, Zhang Kuizheng, He Min, Tang Junping, Zeng Xiaolin, Wu Huilan, Chen Zhiqiang, Liang Zezhi, Qin Xiaoyan, Huang Ling   

  1. Objective　To study the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of urinary tract infection (UTI) through a meta analysis. Methods　PubMed, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Database were searched for related studies published up to November 2021. Two researchers independently judged the studies and extracted the data. Meta analysis was performed by STATA 12.0 software, including evaluation of specificity, sensitivity, likelihood ratio, and odds ratio and drawing summary receiver operating characteristic curve (SROC) and Fagan diagram. Results　In all, 14 studies were enrolled, including 2 362 children and adolescents. The studies were highly heterogeneous, and there was no threshold effect or publication bias. Using a bivariate random effect regression model, we found that for the diagnosis of urinary tract infection, urinary NGAL's summary specificity and sensitivity were 0.82 (95%CI: 0.74-0.88) and 0.82 (95%CI: 0.73-0.89) respectively. Additionally, the negative likelihood ratio, positive likelihood ratio, and diagnostic odds ratio were 4.58 (95%CI: 2.81-7.46), 0.22 (95%CI: 0.14-0.34), and 20.66 (95%CI: 8.64-49.38) respectively. The area under the SROC was 0.89 (95%CI: 0.86-0.91). According to the Fagan diagram, application of urine NGAL to detect urinary tract infection enhanced the prior probability to 20%, increased the probability of positivity to 53%, and reduced the probability of negativity to 5%. Based on the meta-regression analysis, the heterogeneity was due to other covariates. Conclusions　Urinary NGAL is highly effective in diagnosing urinary tract infection in the early stage. Although urinary NGAL may be used in the diagnosis of urinary tract infection, a comprehensive evaluation and analysis of clinical parameters should be performed on every patient.
  • Received:2021-12-27 Online:2022-05-15 Published:2022-05-16
  • Contact: Li Rugang, Email: rugangli1@163.com
  • Supported by:
    Health Research Project of Shaoguan City, Guangdong Province (Y20195)

尿中性粒细胞明胶酶相关脂质运载蛋白对泌尿道感染诊断作用的荟萃分析

李儒刚  黄洁平  张魁正  何敏  唐君平  曾晓琳  吴慧兰  陈志强  梁泽智  秦小燕  黄玲   

  1. 目的　通过荟萃分析探讨尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对泌尿道感染的诊断作用。方法　检索PubMed、Embase、中国知网（CNKI）、万方数据库，搜索时间为建库至2021年11月。2位研究者独立评判了这些研究，并提取了数据。采用STATA 12.0软件行meta分析，包括评价特异度、灵敏度、似然比和诊断比值比，进行敏感性分析及异质性测试，绘制汇总受试者工作特征曲线（SROC）及Fagan图。结果　共纳入14篇文献，包括2 362例儿童青少年。纳入研究间异质性较高，不存在阈值效应及发表偏倚。应用双变量随机效应回归模型分析结果显示，尿NGAL对泌尿道感染诊断的合并灵敏度、特异度分别为0.82（95%CI：0.74～0.88）和0.82（95%CI：0.73～0.89），阳性似然比、阴性似然比、诊断比值比分别为4.58（95%CI：2.81～7.46）、0.22（95%CI：0.14～0.34）、20.66（95%CI：8.64～49.38）。SROC下面积为0.89（95%CI：0.86～0.91）。Fagan图显示应用尿NGAL检测泌尿道感染，可使假定验前概率为20%，增加阳性后概率到53%，并降低阴性后概率到5%。meta回归分析发现异质性来源于其他协变量因素。结论　尿NGAL对泌尿道感染的早期诊断具有较高的潜力及效能。尿NGAL测定可用于泌尿道感染的诊断，但应综合评估患者的病情及结合临床指标作出综合分析。
  • 通讯作者: 李儒刚，Email：rugangli1@163.com
  • 基金资助:
    广东省韶关市卫生健康科研项目（Y20195）

Abstract: Objective　To study the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of urinary tract infection (UTI) through a meta analysis. Methods　PubMed, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Database were searched for related studies published up to November 2021. Two researchers independently judged the studies and extracted the data. Meta analysis was performed by STATA 12.0 software, including evaluation of specificity, sensitivity, likelihood ratio, and odds ratio and drawing summary receiver operating characteristic curve (SROC) and Fagan diagram. Results　In all, 14 studies were enrolled, including 2 362 children and adolescents. The studies were highly heterogeneous, and there was no threshold effect or publication bias. Using a bivariate random effect regression model, we found that for the diagnosis of urinary tract infection, urinary NGAL's summary specificity and sensitivity were 0.82 (95%CI: 0.74-0.88) and 0.82 (95%CI: 0.73-0.89) respectively. Additionally, the negative likelihood ratio, positive likelihood ratio, and diagnostic odds ratio were 4.58 (95%CI: 2.81-7.46), 0.22 (95%CI: 0.14-0.34), and 20.66 (95%CI: 8.64-49.38) respectively. The area under the SROC was 0.89 (95%CI: 0.86-0.91). According to the Fagan diagram, application of urine NGAL to detect urinary tract infection enhanced the prior probability to 20%, increased the probability of positivity to 53%, and reduced the probability of negativity to 5%. Based on the meta-regression analysis, the heterogeneity was due to other covariates. Conclusions　Urinary NGAL is highly effective in diagnosing urinary tract infection in the early stage. Although urinary NGAL may be used in the diagnosis of urinary tract infection, a comprehensive evaluation and analysis of clinical parameters should be performed on every patient.

Key words: Neutrophil gelatinase-associated lipocalin, Urinary tract infection, Diagnosis, Meta analysis

摘要： 目的　通过荟萃分析探讨尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对泌尿道感染的诊断作用。方法　检索PubMed、Embase、中国知网（CNKI）、万方数据库，搜索时间为建库至2021年11月。2位研究者独立评判了这些研究，并提取了数据。采用STATA 12.0软件行meta分析，包括评价特异度、灵敏度、似然比和诊断比值比，进行敏感性分析及异质性测试，绘制汇总受试者工作特征曲线（SROC）及Fagan图。结果　共纳入14篇文献，包括2 362例儿童青少年。纳入研究间异质性较高，不存在阈值效应及发表偏倚。应用双变量随机效应回归模型分析结果显示，尿NGAL对泌尿道感染诊断的合并灵敏度、特异度分别为0.82（95%CI：0.74～0.88）和0.82（95%CI：0.73～0.89），阳性似然比、阴性似然比、诊断比值比分别为4.58（95%CI：2.81～7.46）、0.22（95%CI：0.14～0.34）、20.66（95%CI：8.64～49.38）。SROC下面积为0.89（95%CI：0.86～0.91）。Fagan图显示应用尿NGAL检测泌尿道感染，可使假定验前概率为20%，增加阳性后概率到53%，并降低阴性后概率到5%。meta回归分析发现异质性来源于其他协变量因素。结论　尿NGAL对泌尿道感染的早期诊断具有较高的潜力及效能。尿NGAL测定可用于泌尿道感染的诊断，但应综合评估患者的病情及结合临床指标作出综合分析。

关键词: 中性粒细胞明胶酶相关脂质运载蛋白, 泌尿道感染, 诊断价值, 荟萃分析

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