Open Forum Infect Dis. 2014 Apr 23;1(1):ofu004. doi: 10.1093/ofid/ofu004. eCollection 2014 Mar.
Heparin-binding protein: a diagnostic biomarker of urinary tract infection in adults.
Open forum infectious diseases
Charlott Kjölvmark, Lisa I Påhlman, Per Åkesson, Adam Linder
Affiliations
Affiliations
- Division of Infection Medicine, Hospital of Helsingborg, Helsingborg, Sweden.
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden.
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden ; Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
PMID: 25734078
PMCID: PMC4324176 DOI: 10.1093/ofid/ofu004
Abstract
BACKGROUND: Urinary tract infections (UTIs) are associated with significant morbidity and high frequency of antibiotic prescription. Diagnosing UTI is often difficult, particularly in the critically ill patient and in patients with unspecific and mild symptoms. The standard rapid tests have limited value, and there is a need for more reliable diagnostic tools. Heparin-binding protein (HBP) is released from neutrophils and has previously been studied as a diagnostic and predictive biomarker in different bacterial infections.
METHODS: This prospective survey enrolled adult patients at 2 primary care units and 2 hospital emergency departments, to investigate in urine HBP as a biomarker of UTI. In addition, urine levels of interleukin-6, white blood cells, and nitrite were analyzed and compared with HBP. Based on symptoms of UTI and microbiological findings, patients were classified into different groups, UTI (cystitis and pyelonephritis) and no UTI.
RESULTS: Three hundred ninety patients were evaluated. The prevalence of UTI in the study group was 45.4%. The sensitivity and specificity for HBP in urine as a marker for UTI were 89.2% and 89.8%, respectively. The positive and negative predictive values were 90.2% and 88.8%, respectively. Heparin-binding protein was the best diagnostic marker for UTI, with an area-under-curve value of 0.94 (95% confidence interval, 0.93-0.96). Heparin-binding protein was significantly better in distinguishing cystitis from pyelonephritis, compared with the other markers.
CONCLUSIONS: An elevated level of HBP in the urine is associated with UTI and may be a useful diagnostic marker in adult patients with a suspected UTI.
Keywords: HBP; heparin-binding protein; urinary tract infection
References
- Crit Care. 2012 May 21;16(3):R90 - PubMed
- Cell. 2004 Feb 6;116(3):367-79 - PubMed
- BMC Urol. 2004 Jun 02;4:4 - PubMed
- Scand J Prim Health Care. 2009;27(2):74-9 - PubMed
- Kidney Int Suppl (2011). 2012 Mar;2(1):19-36 - PubMed
- J Mol Med (Berl). 2009 Dec;87(12):1157-64 - PubMed
- JAMA. 2002 May 22-29;287(20):2701-10 - PubMed
- J Invest Dermatol. 2010 May;130(5):1365-72 - PubMed
- Health Technol Assess. 2009 Mar;13(19):iii-iv, ix-xi, 1-73 - PubMed
- Blood. 2002 Mar 1;99(5):1785-93 - PubMed
- Front Microbiol. 2013 Jan 22;4:4 - PubMed
- Am J Clin Pathol. 1991 Nov;96(5):582-8 - PubMed
- Crit Care Med. 2011 Apr;39(4):812-7 - PubMed
- J Infect Dis. 1999 Jan;179(1):172-9 - PubMed
- Nat Med. 2001 Oct;7(10):1123-7 - PubMed
- Clin Infect Dis. 2004 May 15;38 Suppl 4:S341-5 - PubMed
- Pediatr Nephrol. 2012 Aug;27(8):1301-8 - PubMed
- Scand J Clin Lab Invest Suppl. 2000;231:1-86 - PubMed
- J Leukoc Biol. 1999 Oct;66(4):634-43 - PubMed
- Am J Clin Pathol. 2006 Sep;126(3):428-36 - PubMed
- J Innate Immun. 2010;2(5):431-8 - PubMed
- Clin Infect Dis. 2009 Oct 1;49(7):1044-50 - PubMed
- Biomark Insights. 2009 Aug 05;4:111-21 - PubMed
- Ann Fam Med. 2013 Sep-Oct;11(5):442-51 - PubMed
- Ann Intern Med. 2006 Aug 15;145(4):247-54 - PubMed
Publication Types