Diagnostic accuracy of urine biomarkers for urinary tract infection in older women: a case-control study
Abstract
OBJECTIVES
Urinary tract infection (UTI) is common among older women. However, diagnosis is challenging due to frequent chronic lower urinary tract symptoms (LUTS), cognitive impairment, and a high prevalence of asymptomatic bacteriuria (ASB). Current urine diagnostics lack specificity, leading to unnecessary treatment and antimicrobial resistance. This study aimed to evaluate the diagnostic accuracy of twelve urine biomarkers for diagnosing UTI in older women.
METHODS
In this case-control study, cases were women ≥ 65 years with ≥ 2 new-onset LUTS, pyuria and one uropathogen ≥ 104 CFU/mL. Controls were asymptomatic and classified as ASB (one uropathogen ≥ 105 CFU/mL), negative culture or mixed flora. Urine biomarker concentrations were measured through liquid chromatography-mass spectrometry and ELISA. Diagnostic accuracy parameters of individual biomarkers and a biomarker model were derived from ROC curves.
RESULTS
We included 162 community-dwelling and institutionalised older women. Five urine inflammatory biomarkers demonstrated high discriminative ability (AUC ≥ 0.80): interleukin 6 (IL-6), azurocidin, neutrophil gelatinase-associated lipocalin (NGAL), tissue inhibitor of metalloproteinases 2 (TIMP-2), and C-X-C motif chemokine 9 (CXCL-9). Azurocidin exhibited the highest diagnostic accuracy (sensitivity 86% (95% confidence interval (CI) 75-93%) and specificity 89% (95% CI 82-94%) at 16.7 ng/mmol creatinine). A combined biomarker and pyuria model showed improved…
How strong is the evidence?
Evidence Hub reads this as a case-control, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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