Special Edition on Neuro-urology

The association between urine neutrophil gelatinase-associated lipocalin and UTI in people with neurogenic lower urinary tract dysfunction

Abstract

Study design

Secondary analysis of urine samples collected from a prospective within-subject clinical trial.

Objectives

Describe the baseline variation in urine neutrophil gelatinase-associated lipocalin (uNGAL) levels in adults with neurogenic lower urinary tract dysfunction (NLUTD) and determine if uNGAL levels vary according to likelihood of having a UTI.

Setting

Greater Washington D.C. region.

Methods

Urine samples were collected from a cohort of adults with NLUTD from a clinical trial. Samples were divided into groups of “Not UTI”, “Unlikely UTI”, and “Likely UTI” based on symptoms and urine culture results. uNGAL was compared between groups using Kruskal–Wallis and post hoc Dunn’s test. Mixed effects logistic model was used to assess the association of uNGAL and Likely UTI.

Results

Twenty-seven participants provided a total of 104 samples. uNGAL levels were lowest for the No UTI group (n = 29; 37 ng/ml interquartile range (IQR) (15, 71)), intermediate for the Unlikely UTI group (n = 67; 95 ng/ml IQR (37, 161)) and highest for the Likely UTI group (n = 8; 187 ng/ml IQR(146, 224)). uNGAL levels were higher in those with Likely UTI compared to both Unlikely UTI (p < 0.05) and No UTI (p < 0.01). uNGAL had an association with Likely UTI (OR 1.01, 95% CI (1.00–1.02), p = 0.049).

Conclusions

Adults with NLUTD have notable variation in uNGAL levels in the absence of symptoms potentially due to UTI. uNGAL levels are higher in those who are likely to have UTI have higher uNGAL levels compared to those with non-specific symptoms and/or less growth on urine culture. uNGAL may have utility as a marker of UTI in people with NLUTD.

Sponsorship

Patient-Centered Outcomes Research Institute (PCORI) funded this work. Bioporto provided partial salary support for SLG, IL, and OKL. NGAL ELISAs were provided by Bioporto in kind.

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Fig. 1: Urine NGAL levels are elevated in samples with various numbers of urine white blood cells.
Fig. 2: Urine NGAL levels in samples with categorized as No UTI, Unlikely UTI, and Likely UTI.

Data availability

The datasets generated and/or analyzed during the current study are available as Supplementary material.

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Funding

This study was funded by PCORI (AD-1310-08215). Bioporto provided salary support for SLG, IL, and OKL. No other authors received support through Bioporto for this work. NGAL ELISAs were provided by Bioporto in kind.

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Authors

Contributions

CSF was responsible for study design, analyzing the data, interpreting the data, and wrote the first draft of the manuscript. OKL was responsible for running the assays, interpreting the data, and provided critical feedback on the manuscript. AR and IL consented the participants, collected the urine samples, collected symptom data, and provided critical feedback on the manuscript. BMS performed the first step of urine processing, collected the symptom data, provided data management, and provided critical feedback on the manuscript. SLG was responsible for study design, data interpretation, and provided critical feedback on the manuscript.

Corresponding author

Correspondence to Catherine S. Forster.

Ethics declarations

Conflict of interest

Bioporto provided partial salary support for SLG, IL, and OKL and provided the NGAL ELISAs for this work in kind. No other authors received support through Bioporto for this work. Bioporto did not play any role in the design of the study, collection, and analysis of data or the decision to publish.

Ethical approval

This study was approved by the Institutional Review Board at MedStar National Rehabilitation Hospital. All participants underwent the informed consent process. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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Forster, C.S., Lamanna, O.K., Rounds, A. et al. The association between urine neutrophil gelatinase-associated lipocalin and UTI in people with neurogenic lower urinary tract dysfunction. Spinal Cord (2020). https://doi.org/10.1038/s41393-020-00552-x

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