What is the Diagnostic Accuracy of Novel Urine Biomarkers for Urinary Tract Infection?
Background: Urinary tract infection (UTI) affects half of women at least once in their lifetime. Current diagnosis involves urinary dipstick and urine culture, yet both methods have modest diagnostic accuracy, and cannot support decision-making in patient populations with high prevalence of asymptom...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-01-01
|
| Series: | Biomarker Insights |
| Online Access: | https://doi.org/10.1177/11772719221144459 |
| _version_ | 1828048460514852864 |
|---|---|
| author | George Edwards Anna Seeley Adam Carter Maia Patrick Smith Elizabeth LA Cross Kathryn Hughes Ann Van den Bruel Martin J Llewelyn Jan Y Verbakel Gail Hayward |
| author_facet | George Edwards Anna Seeley Adam Carter Maia Patrick Smith Elizabeth LA Cross Kathryn Hughes Ann Van den Bruel Martin J Llewelyn Jan Y Verbakel Gail Hayward |
| author_sort | George Edwards |
| collection | DOAJ |
| description | Background: Urinary tract infection (UTI) affects half of women at least once in their lifetime. Current diagnosis involves urinary dipstick and urine culture, yet both methods have modest diagnostic accuracy, and cannot support decision-making in patient populations with high prevalence of asymptomatic bacteriuria, such as older adults. Detecting biomarkers of host response in the urine of hosts has the potential to improve diagnosis. Objectives: To synthesise the evidence of the diagnostic accuracy of novel biomarkers for UTI, and of their ability to differentiate UTI from asymptomatic bacteriuria. Design: A systematic review. Data Sources and Methods: We searched MEDLINE, EMBASE, CINAHL and Web of Science for studies of novel biomarkers for the diagnosis of UTI. We excluded studies assessing biomarkers included in urine dipsticks as these have been well described previously. We included studies of adult patients (≥16 years) with a suspected or confirmed urinary tract infection using microscopy and culture as the reference standard. We excluded studies using clinical signs and symptoms, or urine dipstick only as a reference standard. Quality appraisal was performed using QUADAS-2. We summarised our data using point estimates and data accuracy statistics. Results: We included 37 studies on 4009 adults measuring 66 biomarkers. Study quality was limited by case-control design and study size; only 4 included studies had a prospective cohort design. IL-6 and IL-8 were the most studied biomarkers. We found plausible evidence to suggest that IL-8, IL-6, GRO-a, sTNF-1, sTNF-2 and MCR may benefit from more rigorous evaluation of their potential diagnostic value for UTI. Conclusions: There is insufficient evidence to recommend the use of any novel biomarker for UTI diagnosis at present. Further evaluation of the more promising candidates, is needed before they can be recommended for clinical use. |
| first_indexed | 2024-04-10T18:57:48Z |
| format | Article |
| id | doaj.art-515e0813e16440f6895fc005e1b7d0e6 |
| institution | Directory Open Access Journal |
| issn | 1177-2719 |
| language | English |
| last_indexed | 2024-04-10T18:57:48Z |
| publishDate | 2023-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Biomarker Insights |
| spelling | doaj.art-515e0813e16440f6895fc005e1b7d0e62023-01-31T16:03:20ZengSAGE PublishingBiomarker Insights1177-27192023-01-011810.1177/11772719221144459What is the Diagnostic Accuracy of Novel Urine Biomarkers for Urinary Tract Infection?George Edwards0Anna Seeley1Adam Carter2Maia Patrick Smith3Elizabeth LA Cross4Kathryn Hughes5Ann Van den Bruel6Martin J Llewelyn7Jan Y Verbakel8Gail Hayward9NIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKDepartment of Global Health and Infection, Brighton and Sussex Medical School, Falmer, UKPRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UKEPI-Centre, Academic Centre for General Practice, KU Leuven, Leuven, BelgiumDepartment of Global Health and Infection, Brighton and Sussex Medical School, Falmer, UKEPI-Centre, Academic Centre for General Practice, KU Leuven, Leuven, BelgiumNIHR Community Healthcare Medtech and IVD Cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBackground: Urinary tract infection (UTI) affects half of women at least once in their lifetime. Current diagnosis involves urinary dipstick and urine culture, yet both methods have modest diagnostic accuracy, and cannot support decision-making in patient populations with high prevalence of asymptomatic bacteriuria, such as older adults. Detecting biomarkers of host response in the urine of hosts has the potential to improve diagnosis. Objectives: To synthesise the evidence of the diagnostic accuracy of novel biomarkers for UTI, and of their ability to differentiate UTI from asymptomatic bacteriuria. Design: A systematic review. Data Sources and Methods: We searched MEDLINE, EMBASE, CINAHL and Web of Science for studies of novel biomarkers for the diagnosis of UTI. We excluded studies assessing biomarkers included in urine dipsticks as these have been well described previously. We included studies of adult patients (≥16 years) with a suspected or confirmed urinary tract infection using microscopy and culture as the reference standard. We excluded studies using clinical signs and symptoms, or urine dipstick only as a reference standard. Quality appraisal was performed using QUADAS-2. We summarised our data using point estimates and data accuracy statistics. Results: We included 37 studies on 4009 adults measuring 66 biomarkers. Study quality was limited by case-control design and study size; only 4 included studies had a prospective cohort design. IL-6 and IL-8 were the most studied biomarkers. We found plausible evidence to suggest that IL-8, IL-6, GRO-a, sTNF-1, sTNF-2 and MCR may benefit from more rigorous evaluation of their potential diagnostic value for UTI. Conclusions: There is insufficient evidence to recommend the use of any novel biomarker for UTI diagnosis at present. Further evaluation of the more promising candidates, is needed before they can be recommended for clinical use.https://doi.org/10.1177/11772719221144459 |
| spellingShingle | George Edwards Anna Seeley Adam Carter Maia Patrick Smith Elizabeth LA Cross Kathryn Hughes Ann Van den Bruel Martin J Llewelyn Jan Y Verbakel Gail Hayward What is the Diagnostic Accuracy of Novel Urine Biomarkers for Urinary Tract Infection? Biomarker Insights |
| title | What is the Diagnostic Accuracy of Novel Urine Biomarkers for Urinary Tract Infection? |
| title_full | What is the Diagnostic Accuracy of Novel Urine Biomarkers for Urinary Tract Infection? |
| title_fullStr | What is the Diagnostic Accuracy of Novel Urine Biomarkers for Urinary Tract Infection? |
| title_full_unstemmed | What is the Diagnostic Accuracy of Novel Urine Biomarkers for Urinary Tract Infection? |
| title_short | What is the Diagnostic Accuracy of Novel Urine Biomarkers for Urinary Tract Infection? |
| title_sort | what is the diagnostic accuracy of novel urine biomarkers for urinary tract infection |
| url | https://doi.org/10.1177/11772719221144459 |
| work_keys_str_mv | AT georgeedwards whatisthediagnosticaccuracyofnovelurinebiomarkersforurinarytractinfection AT annaseeley whatisthediagnosticaccuracyofnovelurinebiomarkersforurinarytractinfection AT adamcarter whatisthediagnosticaccuracyofnovelurinebiomarkersforurinarytractinfection AT maiapatricksmith whatisthediagnosticaccuracyofnovelurinebiomarkersforurinarytractinfection AT elizabethlacross whatisthediagnosticaccuracyofnovelurinebiomarkersforurinarytractinfection AT kathrynhughes whatisthediagnosticaccuracyofnovelurinebiomarkersforurinarytractinfection AT annvandenbruel whatisthediagnosticaccuracyofnovelurinebiomarkersforurinarytractinfection AT martinjllewelyn whatisthediagnosticaccuracyofnovelurinebiomarkersforurinarytractinfection AT janyverbakel whatisthediagnosticaccuracyofnovelurinebiomarkersforurinarytractinfection AT gailhayward whatisthediagnosticaccuracyofnovelurinebiomarkersforurinarytractinfection |