Pub Date : 2022-01-04DOI: 10.1097/ID9.0000000000000038
Haotang Ren, Junjie Yao, Ruihong Zhao, K. Gong, Shanshan Sun, Xia Yu, Wei Shen, Jinnan Duan, J. Sheng, Yu Shi
Abstract Background: Bacterial infections are common in patients with decompensated cirrhosis, largely owing to bacterial translocation and cirrhosis-associated immune dysfunction. This study aims to determine the reliability for classifying infections in patients with decompensated cirrhosis based on the Centers for Disease Control and Prevention (CDC) criteria. Methods: The patients with decompensated cirrhosis with suspicious infection in a registered prospective cohort of cirrhosis from May 1, 2014 to February 25, 2015 in the ward of First Affiliated Hospital of Zhejiang University were retrospectively identified. Agreement assessment was conducted focusing on site of infection, the possibility of infection, and pathogens of infection on both system level and specific diagnosis level. A subgroup analysis was performed based on with/without acute-on-chronic liver failure (ACLF). Results: A total of 402 infectious episodes among 351 patients were enrolled for consistency analysis. The overall agreement for site of infection was 94% (378/402) (k = 0.90, 95% CI 0.86–0.94) on system level and 86% (346/402) (k = 0.84, 95% CI 0.80–0.88) on specific diagnosis level. On possibility of infection, the overall agreement was 81% (306/378) (weighted k = 0.71, 95% CI 0.65–0.77), with 84% (224/267) (weighted k = 0.75, 95% CI 0.63–0.87) in patients with ACLF and 80% (70/88) (weighted k = 0.68, 95% CI 0.60–0.76) in patients without ACLF, respectively. On pathogens of infection, the overall agreement was 72% (60/83) (k = 0.70, 95% CI 0.60–0.80) among most frequent infections. Conclusion: The agreement for classifying infections in patients with decompensated cirrhosis based on CDC criteria is acceptable overall, suggesting that it can be a useful tool for clinical management in patients with decompensated cirrhosis with suspicious infections.
{"title":"Interobserver Agreement for Classifying Infections in Patients with Decompensated Cirrhosis Based on Centers for Disease Control and Prevention Criteria","authors":"Haotang Ren, Junjie Yao, Ruihong Zhao, K. Gong, Shanshan Sun, Xia Yu, Wei Shen, Jinnan Duan, J. Sheng, Yu Shi","doi":"10.1097/ID9.0000000000000038","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000038","url":null,"abstract":"Abstract Background: Bacterial infections are common in patients with decompensated cirrhosis, largely owing to bacterial translocation and cirrhosis-associated immune dysfunction. This study aims to determine the reliability for classifying infections in patients with decompensated cirrhosis based on the Centers for Disease Control and Prevention (CDC) criteria. Methods: The patients with decompensated cirrhosis with suspicious infection in a registered prospective cohort of cirrhosis from May 1, 2014 to February 25, 2015 in the ward of First Affiliated Hospital of Zhejiang University were retrospectively identified. Agreement assessment was conducted focusing on site of infection, the possibility of infection, and pathogens of infection on both system level and specific diagnosis level. A subgroup analysis was performed based on with/without acute-on-chronic liver failure (ACLF). Results: A total of 402 infectious episodes among 351 patients were enrolled for consistency analysis. The overall agreement for site of infection was 94% (378/402) (k = 0.90, 95% CI 0.86–0.94) on system level and 86% (346/402) (k = 0.84, 95% CI 0.80–0.88) on specific diagnosis level. On possibility of infection, the overall agreement was 81% (306/378) (weighted k = 0.71, 95% CI 0.65–0.77), with 84% (224/267) (weighted k = 0.75, 95% CI 0.63–0.87) in patients with ACLF and 80% (70/88) (weighted k = 0.68, 95% CI 0.60–0.76) in patients without ACLF, respectively. On pathogens of infection, the overall agreement was 72% (60/83) (k = 0.70, 95% CI 0.60–0.80) among most frequent infections. Conclusion: The agreement for classifying infections in patients with decompensated cirrhosis based on CDC criteria is acceptable overall, suggesting that it can be a useful tool for clinical management in patients with decompensated cirrhosis with suspicious infections.","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45049191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.1097/ID9.0000000000000027
Lin Gao, Xiuying Mu, Yan-Mei Jiao, Fu-Sheng Wang
The pandemic of coronavirus disease 2019 has threatened humans for more than one and a half years. In particular, viral mutation like delta strain has led to third- or fourth-wave transmission among the countries in Asia, Europe, and North America. Although large-scale vaccination has been carried out in many countries, the incidence of reinfection and vaccine-past breakthrough infection is becoming an emerging challenge to humans worldwide. The related mechanisms underlying the reinfection and breakthrough infection remain unknown. In this review, we summarized the challenge and related reasons for severe acute respiratory syndrome coronavirus 2 reinfection and breakthrough infection. Simultaneously, we addressed some critical contents of the study in future.
{"title":"Reinfection and Breakthrough Infection of SARS-CoV-2: An Emerging Challenge That Is Threatening Our World.","authors":"Lin Gao, Xiuying Mu, Yan-Mei Jiao, Fu-Sheng Wang","doi":"10.1097/ID9.0000000000000027","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000027","url":null,"abstract":"<p><p>The pandemic of coronavirus disease 2019 has threatened humans for more than one and a half years. In particular, viral mutation like delta strain has led to third- or fourth-wave transmission among the countries in Asia, Europe, and North America. Although large-scale vaccination has been carried out in many countries, the incidence of reinfection and vaccine-past breakthrough infection is becoming an emerging challenge to humans worldwide. The related mechanisms underlying the reinfection and breakthrough infection remain unknown. In this review, we summarized the challenge and related reasons for severe acute respiratory syndrome coronavirus 2 reinfection and breakthrough infection. Simultaneously, we addressed some critical contents of the study in future.</p>","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/25/4a/id9-2-29.PMC8772053.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10314773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.1097/ID9.0000000000000033
Zhanjun Shu, Peipei Wu, Qianqian Qian, Li Zhou, Dandan Du, Mengxuan Ding, Tao Peng, Ke Fang
Since the coronavirus disease 2019 (COVID-19) began to spread, it remains pandemic worldwide. The European Medicines Agency's human medicines committee and Food and Drug Administration have only granted a conditional marketing authorization for remdesivir to treat COVID-19. It is essential to apply other valuable treatments. Convalescent plasma (CP), donated by persons who have recovered from COVID-19, is the cellular component of blood that contains specific antibodies. Therefore, to determine the feasibility of CP for COVID-19, the effectiveness and controversy are discussed in depth here. It is suggested that CP plays a certain role in the treatment of COVID-19. As a treatment, it may have its own indications and contraindications, which need to be further discussed. Meanwhile, it is critical to establish a standard procedure for treatment from CP collection, preservation, transport, to transfusion, and conduct some large sample randomized controlled trials to confirm the transfusion dosage, appropriate time, frequency, and actively prevent adverse outcomes that may occur.
{"title":"Effectiveness and Controversy of Convalescent Plasma Therapy for Coronavirus Disease 2019 Patients.","authors":"Zhanjun Shu, Peipei Wu, Qianqian Qian, Li Zhou, Dandan Du, Mengxuan Ding, Tao Peng, Ke Fang","doi":"10.1097/ID9.0000000000000033","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000033","url":null,"abstract":"<p><p>Since the coronavirus disease 2019 (COVID-19) began to spread, it remains pandemic worldwide. The European Medicines Agency's human medicines committee and Food and Drug Administration have only granted a conditional marketing authorization for remdesivir to treat COVID-19. It is essential to apply other valuable treatments. Convalescent plasma (CP), donated by persons who have recovered from COVID-19, is the cellular component of blood that contains specific antibodies. Therefore, to determine the feasibility of CP for COVID-19, the effectiveness and controversy are discussed in depth here. It is suggested that CP plays a certain role in the treatment of COVID-19. As a treatment, it may have its own indications and contraindications, which need to be further discussed. Meanwhile, it is critical to establish a standard procedure for treatment from CP collection, preservation, transport, to transfusion, and conduct some large sample randomized controlled trials to confirm the transfusion dosage, appropriate time, frequency, and actively prevent adverse outcomes that may occur.</p>","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5b/c6/id9-2-49.PMC8772051.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9964438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-20DOI: 10.1097/ID9.0000000000000035
T. Feng, Xiaoxue Hou, Wen Zhang, Anran Tian, Nian Chen, Jun Li, Chuanlong Zhu
Abstract Background: Splenectomy has been reported to improve liver function as well as hypersplenism, but it is still controversial whether splenectomy will further damage the immune function of patients with liver cirrhosis. This study aims to evaluate the impact of splenectomy on the risk of infection in patients with liver cirrhosis. Methods: A total of 4355 patients with liver cirrhosis admitted to the First Affiliated Hospital of Nanjing Medical University from October 1, 2016 to September 30, 2020 were enrolled. The patients were first divided into the splenectomy group (SG) and the non-splenectomy group (NSG). After standardization, patients were further divided according to the stage of cirrhosis. Infection rates in different stages were calculated, respectively. Laboratory results and infection sites of patients with cirrhosis were analyzed in combination with clinical data. Continuous variables conforming to normal distribution were presented as mean ± standard deviation, compared by sample t test or paired sample t test. Non-normal variables were presented as the median (interquartile range) and compared by Mann-Whitney U test or Wilcoxon signed rank test. Results: Five hundred and two patients received splenectomy and 3853 patients did not. Bacterial infection was diagnosed in 497 of the 4355 (11.41%) hospitalizations of patients with cirrhosis. The infection rate of the compensated cirrhosis SG was higher than that of the NSG (8.06% vs. 5.18%, P < 0.05). However, the infection rate in the SG with decompensated cirrhosis was lower than that in the NSG (11.35% vs. 22.22%, P < 0.001). The peak level of leukocytes did not differ significantly between the SG with compensated liver cirrhosis and the NSG [11.97 (7.65) × 109/L vs. 12.19 (14.04) × 109/L, P > 0. 05]. The peak value of leukocytes in SG suffering from decompensated liver cirrhosis was significantly higher than that in NSG [12.29 (11.52) × 109/L vs. 6.37 (8.90) × 109/L, P = 0.004]. Patients with decompensated liver cirrhosis had a significantly higher rate of abdominal infection than patients with compensated liver cirrhosis, and splenectomy itself did not affect the sites of infection. Conclusions: Splenectomy increases the risk of infection for patients with compensated liver cirrhosis, but significantly decreases the risk in patients with decompensated liver cirrhosis.
{"title":"The Effect of Splenectomy on the Risk of Infection in Patients With Liver Cirrhosis","authors":"T. Feng, Xiaoxue Hou, Wen Zhang, Anran Tian, Nian Chen, Jun Li, Chuanlong Zhu","doi":"10.1097/ID9.0000000000000035","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000035","url":null,"abstract":"Abstract Background: Splenectomy has been reported to improve liver function as well as hypersplenism, but it is still controversial whether splenectomy will further damage the immune function of patients with liver cirrhosis. This study aims to evaluate the impact of splenectomy on the risk of infection in patients with liver cirrhosis. Methods: A total of 4355 patients with liver cirrhosis admitted to the First Affiliated Hospital of Nanjing Medical University from October 1, 2016 to September 30, 2020 were enrolled. The patients were first divided into the splenectomy group (SG) and the non-splenectomy group (NSG). After standardization, patients were further divided according to the stage of cirrhosis. Infection rates in different stages were calculated, respectively. Laboratory results and infection sites of patients with cirrhosis were analyzed in combination with clinical data. Continuous variables conforming to normal distribution were presented as mean ± standard deviation, compared by sample t test or paired sample t test. Non-normal variables were presented as the median (interquartile range) and compared by Mann-Whitney U test or Wilcoxon signed rank test. Results: Five hundred and two patients received splenectomy and 3853 patients did not. Bacterial infection was diagnosed in 497 of the 4355 (11.41%) hospitalizations of patients with cirrhosis. The infection rate of the compensated cirrhosis SG was higher than that of the NSG (8.06% vs. 5.18%, P < 0.05). However, the infection rate in the SG with decompensated cirrhosis was lower than that in the NSG (11.35% vs. 22.22%, P < 0.001). The peak level of leukocytes did not differ significantly between the SG with compensated liver cirrhosis and the NSG [11.97 (7.65) × 109/L vs. 12.19 (14.04) × 109/L, P > 0. 05]. The peak value of leukocytes in SG suffering from decompensated liver cirrhosis was significantly higher than that in NSG [12.29 (11.52) × 109/L vs. 6.37 (8.90) × 109/L, P = 0.004]. Patients with decompensated liver cirrhosis had a significantly higher rate of abdominal infection than patients with compensated liver cirrhosis, and splenectomy itself did not affect the sites of infection. Conclusions: Splenectomy increases the risk of infection for patients with compensated liver cirrhosis, but significantly decreases the risk in patients with decompensated liver cirrhosis.","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47922731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-03DOI: 10.1097/ID9.0000000000000034
W. Lu, L. Bai, Yu Chen
Abstract Exosomes (exos) widely distributed in a variety of biological fluids, including blood, urine, saliva, sputum, breast milk, cerebrospinal fluid, and ascites, contain specific bioactive contents which are involved in physiological and pathological processes, such as signal molecular transfer, substance metabolism, gene regulation, and immune regulation. Macrophages are important innate immune cells which usually act as the first line of defense against infection, and can switch between different functional phenotypes in response to the changes around the microenvironment. Evidence suggests that macrophage-derived exos exert a crucial effect on infection, inflammation, regeneration, tumors, fibrosis, and other lesions in multiple human diseases. However, the role and mechanism of macrophage-derived exos in liver diseases remain to be explored. This review summarizes the current researches on the role and possible mechanism of macrophage-derived exos in liver diseases, with the purpose of providing new potential targets and directions for diagnostic biomarker and clinical treatment of liver diseases.
{"title":"The Role of Macrophage-Derived Exosomes in Liver Diseases","authors":"W. Lu, L. Bai, Yu Chen","doi":"10.1097/ID9.0000000000000034","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000034","url":null,"abstract":"Abstract Exosomes (exos) widely distributed in a variety of biological fluids, including blood, urine, saliva, sputum, breast milk, cerebrospinal fluid, and ascites, contain specific bioactive contents which are involved in physiological and pathological processes, such as signal molecular transfer, substance metabolism, gene regulation, and immune regulation. Macrophages are important innate immune cells which usually act as the first line of defense against infection, and can switch between different functional phenotypes in response to the changes around the microenvironment. Evidence suggests that macrophage-derived exos exert a crucial effect on infection, inflammation, regeneration, tumors, fibrosis, and other lesions in multiple human diseases. However, the role and mechanism of macrophage-derived exos in liver diseases remain to be explored. This review summarizes the current researches on the role and possible mechanism of macrophage-derived exos in liver diseases, with the purpose of providing new potential targets and directions for diagnostic biomarker and clinical treatment of liver diseases.","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44504767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-02DOI: 10.1097/ID9.0000000000000032
Anne P. Lomole, W. Macharia, M. Limbe, D. Kinuthia, S. Kabinga
Abstract Background: About 75% of patients infected with human immunodeficiency virus (HIV) live in sub-Saharan Africa. In Kenya, about 1.5 million Kenyans are living with HIV, of whom almost 100,000 are children and adolescents. Highly active antiretroviral therapy (HAART) has converted HIV infection to a chronic illness with its attendant complications. Kidney disease is a common complication of HIV infection and its treatment. Kidney disease in HIV-infected persons can be asymptomatic, insidious onset and may lack specific clinical features. It can only be detected on active screening. The urine albumin-to-creatinine ratio and estimated glomerular filtration rate (eGFR) using serum creatinine are not sensitive in identification of early kidney injury. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been used as marker of early kidney injury. Methods: This cross-sectional study used uNGAL and serum creatinine to determine the prevalence of kidney dysfunction in HIV-infected children and adolescents with HAART at Gertrude's Children's Hospital, Nairobi, Kenya, from March 2016 to February 2017. Urine samples were assayed for uNGAL using the Bio Porto® enzyme-linked immunosorbent assay. Serum creatinine was assayed using the Jaffe reaction in the Cobas® 6000 biochemistry analyzer and eGFR calculated using the Schwartz formula. Scatter plot of eGFR against log uNGAL levles was performed by Statistical Package for Social Sciences and Pearson correlation coefficeint between log uNGAL levles and eGFR was analyzed. Results: Ninety-three patients were recruited. Their mean age was 11.8 ± 3.6 years and the median duration on HAART was 72.6 months. Males were 47 (50.5%). The prevalence of kidney dysfunction using uNGAL was 15.1% (95% CI 7.6%–22.5%) and 5.4% (95% CI 1.8%–12.1%) by eGFR. The mean eGFR was 131 ± 25 mL·min−1·1.73 m−2 and median uNGAL was 10 ng/mL. For every one ng/mL increase in uNGAL value above the normal value, eGFR decreases by 4.8 mL·min−1·1.73 m−2 (P = 0.038). Patients with elevated uNGAL were older when compared with those with normal uNGAL (13.5 vs. 11.5 years). Conclusion: Urinary NGAL picked up to three times more patients with kidney dysfunction than eGFR derived from serum creatinine. All the patients were asymptomatic. Older children and adolescents were more likely to manifest with kidney dysfunction. Further studies are necessary to evaluate if uNGAL can be utilized routinely to evaluate for early kidney disease in HIV-infected patients.
背景:约75%的人类免疫缺陷病毒(HIV)感染者生活在撒哈拉以南非洲地区。在肯尼亚，大约有150万肯尼亚人感染了艾滋病毒，其中近10万是儿童和青少年。高效抗逆转录病毒疗法(HAART)已将艾滋病毒感染转化为伴随并发症的慢性疾病。肾脏疾病是HIV感染及其治疗的常见并发症。肾脏疾病在hiv感染者可以是无症状的，潜伏的开始和可能缺乏特定的临床特征。它只能在主动筛查中检测到。尿白蛋白与肌酐比值和用血清肌酐估算肾小球滤过率(eGFR)对早期肾损伤的鉴别不敏感。尿中性粒细胞明胶酶相关脂钙蛋白(uNGAL)已被用作早期肾损伤的标志物。方法:这项横断面研究使用uNGAL和血清肌酐来确定2016年3月至2017年2月在肯尼亚内罗毕格特鲁德儿童医院接受HAART治疗的hiv感染儿童和青少年肾功能障碍的患病率。使用Bio Porto®酶联免疫吸附法检测尿液样本中的uNGAL。使用Cobas®6000生化分析仪中的Jaffe反应检测血清肌酐，使用Schwartz公式计算eGFR。利用社会科学统计软件包(Statistical Package for Social Sciences)绘制eGFR与对数uNGAL水平的散点图，分析对数uNGAL水平与eGFR之间的Pearson相关系数。结果:共纳入93例患者。他们的平均年龄为11.8±3.6岁，HAART治疗的中位时间为72.6个月。男性47例(50.5%)。根据eGFR, uNGAL的肾功能不全发生率分别为15.1% (95% CI 7.6%-22.5%)和5.4% (95% CI 1.8%-12.1%)。平均eGFR为131±25 mL·min - 1·1.73 m - 2，中位uNGAL为10 ng/mL。uNGAL每高于正常值1 ng/mL, eGFR降低4.8 mL·min−1·1.73 m−2 (P = 0.038)。与uNGAL正常的患者相比，uNGAL升高的患者年龄更大(13.5岁vs 11.5岁)。结论:尿NGAL检出率是血清肌酐eGFR检出率的3倍。所有患者均无症状。年龄较大的儿童和青少年更容易表现为肾功能不全。需要进一步的研究来评估uNGAL是否可以常规用于评估艾滋病毒感染患者的早期肾脏疾病。
{"title":"Estimation of Burden of Kidney Dysfunction in HIV-Infected Pediatrics and Adolescents by Use of Urinary Neutrophil Gelatinase-Associated Lipocalin: A Single Center Experience in Kenya","authors":"Anne P. Lomole, W. Macharia, M. Limbe, D. Kinuthia, S. Kabinga","doi":"10.1097/ID9.0000000000000032","DOIUrl":"https://doi.org/10.1097/ID9.0000000000000032","url":null,"abstract":"Abstract Background: About 75% of patients infected with human immunodeficiency virus (HIV) live in sub-Saharan Africa. In Kenya, about 1.5 million Kenyans are living with HIV, of whom almost 100,000 are children and adolescents. Highly active antiretroviral therapy (HAART) has converted HIV infection to a chronic illness with its attendant complications. Kidney disease is a common complication of HIV infection and its treatment. Kidney disease in HIV-infected persons can be asymptomatic, insidious onset and may lack specific clinical features. It can only be detected on active screening. The urine albumin-to-creatinine ratio and estimated glomerular filtration rate (eGFR) using serum creatinine are not sensitive in identification of early kidney injury. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been used as marker of early kidney injury. Methods: This cross-sectional study used uNGAL and serum creatinine to determine the prevalence of kidney dysfunction in HIV-infected children and adolescents with HAART at Gertrude's Children's Hospital, Nairobi, Kenya, from March 2016 to February 2017. Urine samples were assayed for uNGAL using the Bio Porto® enzyme-linked immunosorbent assay. Serum creatinine was assayed using the Jaffe reaction in the Cobas® 6000 biochemistry analyzer and eGFR calculated using the Schwartz formula. Scatter plot of eGFR against log uNGAL levles was performed by Statistical Package for Social Sciences and Pearson correlation coefficeint between log uNGAL levles and eGFR was analyzed. Results: Ninety-three patients were recruited. Their mean age was 11.8 ± 3.6 years and the median duration on HAART was 72.6 months. Males were 47 (50.5%). The prevalence of kidney dysfunction using uNGAL was 15.1% (95% CI 7.6%–22.5%) and 5.4% (95% CI 1.8%–12.1%) by eGFR. The mean eGFR was 131 ± 25 mL·min−1·1.73 m−2 and median uNGAL was 10 ng/mL. For every one ng/mL increase in uNGAL value above the normal value, eGFR decreases by 4.8 mL·min−1·1.73 m−2 (P = 0.038). Patients with elevated uNGAL were older when compared with those with normal uNGAL (13.5 vs. 11.5 years). Conclusion: Urinary NGAL picked up to three times more patients with kidney dysfunction than eGFR derived from serum creatinine. All the patients were asymptomatic. Older children and adolescents were more likely to manifest with kidney dysfunction. Further studies are necessary to evaluate if uNGAL can be utilized routinely to evaluate for early kidney disease in HIV-infected patients.","PeriodicalId":73371,"journal":{"name":"Infectious diseases & immunity","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44021343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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