Ann Lab Med 2018; 38(1): 39-45  
Urinary YKL-40 as a Candidate Biomarker for Febrile Urinary Tract Infection in Young Children
Hyun Hee Kim, M.D.1, Mi Hae Chung, M.D.2, Joong Hyun Bin, M.D.2, Kyoung Soon Cho, M.D.2, Juyoung Lee, M.D.2, and Jin-Soon Suh, M.D.2
Department of Pediatrics1, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul; Department of Pediatrics2, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Jin-Soon Suh
Department of Pediatrics, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro 327beon-gil, Wonmi-gu, Bucheon 14647, Korea
Tel: +82-32-340-7047
Fax: +82-32-340-2673
E-mail: rebekahjs@hanmail.net
Received: April 4, 2017; Revised: June 12, 2017; Accepted: September 19, 2017; Published online: January 1, 2018.
© The Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Given that YKL-40 is a known marker of inflammation, we sought to determine its association with urinary tract infection (UTI) in febrile children.
Methods: In total, 44 children aged 0 to 24 months with febrile UTI and 35 age- and sex-matched controls with fever from other causes were enrolled in the study. ELISA was performed to determine the level of YKL-40 in urine collected from each child.
Results: The ratio of urinary YKL-40 to creatinine (Cr) was higher in the children with a UTI than in the controls (P〈0.001). The area under the ROC curve for detecting UTI was 0.88 for the urinary YKL-40/Cr ratio, 0.86 for pyuria, and 0.71 for positive nitrite on urinalysis. We applied a cut-off value of 125.23 pg/mg to urinary YKL-40/Cr for detecting UTI. Eight of nine children in the control group with pyuria had urinary YKL-40/Cr levels lower than 125.23 pg/mg, and the one child in the UTI group without pyuria or positive nitrite had a urinary YKL-40/Cr level greater than 125.23 pg/mg.
Conclusions: Determining the levels of urinary YKL-40/Cr may help identify true cases of UTI in febrile young children, especially when they have pyuria but not nitrite, or have neither pyuria nor nitrite in the urine.
Keywords: Biomarker, Children, Fever, Urinary tract infection, YKL-40


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