Urinary Intestinal Fatty Acid Binding Protein for Diagnosis of Necrotizing Enterocolitis
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Urinary Intestinal Fatty Acid Binding Protein for Diagnosis of Necrotizing Enterocolitis AMARNATH SARAN1, DEVANANDA DEVEGOWDA2 AND SRINIVASA MURTHY DORESWAMY1 From Departments of 1Pediatrics and 2Biochemistry, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India. Corresponding to: Dr Srinivasa Murthy Doreswamy, Professor in Pediatrics, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru 570001, Karnataka, India. [email protected] Submitted: February 10, 2019; Initial review: June 10, 2019; Accepted: April 05, 2020.
Objective: This study was conducted to compare the urinary levels of intestinal fatty acid binding protein (I-FABP) and I-FABP: Cr (creatinine) between neonates with necrotising enterocolitis and gestation matched healthy controls. Methods: 24 neonates with stage 1, 25 with stage 2 and 3 necrotizing enterocolitis, and 25 gestation matched (32.9 wk) controls were compared. Single spot urine sample was collected for estimating the IFABP and creatinine levels. Results: Median (IQR) value of urinary I-FABP were higher in those with stage 2, 3 NEC [2773 (2417.7- 2820)] than stage 1 NEC [1164 pg/mL (1341.5 – 2213.4)] and controls [413 (113 – 729.7); pg/mL] (P0.05 for all inter-group comparisons; All values in no. (%) except #mean (SD) *median (IQR).
Earlier studies have reported cut-off values of IFABP: Cr ratio ranging from 2 to 5 pg/mmoL for diagnosis of NEC [19,14]. The variations in cut-off values is due to different priorities regarding sensitivity and specificity, and the sample size. Our study showed high specificity, and has good sensitivity for urine IFABP: Cr level of 3.6 pg/mmoL for stage 2 and 3 NEC. As diagnostic tests are done on clinical suspicion, even if the pre test probability is about 50%, the post test probability would be greater than 98%.
91.8% and specificity of 92% in diagnosing stage 1 NEC and a value of 1800pg/mL had a sensitivity of 88% and specificity of 82% in diagnosing stage 2 and stage 3 NEC. Urinary I-FABP: Cr ratio of 2.1pg/mL had a sensitivity of 83.3% (95% CI 66.4, 95.3%) and specificity of 96% (95% CI 87, 99.8%) for the diagnosis of stage 1 NEC. True positive rate, true negative rate, positive likelihood ratio and negative likelihood ratio were 91.8% (79.5-97.3%), 96% (77%-99.7%), 11.3 (4.428.9), 0.04(0.006-0.28), respectively. A higher ratio of 3.6 pg/mmoL had a sensitivity of 96% (95% CI 69.7, 97%) and specificity of 99.5% (95% CI 87.2, 99.8%) for diagnosis of stage 2 and 3 NEC; area under the curve was 0.99%. True positive rate, true negative rate, positive likelihood ratio and negative likelihood ratio were 96% (77.6-99.7%), 93.8% (82-98.4%), 24 (3.5-164), 0.06 (0.02-0.19), respectively.
The present study did not prospectively collect data with regard to respiratory support, sepsis or asphyxia, which may be considered as a study limitation. To conclude, urinary I-FABP is significantly elevated in neonates with NEC. Urinary I-FABP: Creatine ratio performed better than urinary I-FABP alone for diagnosi
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