Novel biomarker combination improves the diagnosis of serious bacterial infections in Malawian children

Adam D. Irwin, Fiona Marriage, Limangeni A. Mankhambo, Graham Jeffers, Ruwanthi Kolamunnage-Dona, Malcolm Guiver, Brigitte Denis, Elizabeth M. Molyneux, Malcolm E. Molyneux, Philip J. Day, Enitan D. Carrol*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


Background: High throughput technologies offer insight into disease processes and heightens opportunities for improved diagnostics. Using transcriptomic analyses, we aimed to discover and to evaluate the clinical validity of a combination of reliable and functionally important biomarkers of serious bacterial infection (SBI). Methods. We identified three previously reported biomarkers of infection (neutrophil gelatinase-associated lipocalin (NGAL), granulysin and resistin) and measured gene expression using quantitative real-time PCR. Protein products related to the three transcripts were measured by immunoassays. Results: Relative gene expression values of NGAL and resistin were significantly increased, and expression of granulysin significantly decreased in cases compared to controls. Plasma concentrations of NGAL and resistin were significantly increased in children with confirmed SBI compared to children with no detectable bacterial infection (NBI), and to controls (287 versus 128 versus 62 ng/ml and 195 versus 90 versus 18 ng/ml, respectively, p < 0.05). Plasma protein concentrations of NGAL and resistin were significantly increased in non-survivors compared to survivors (306 versus 211 and 214 versus 150 ng/ml, p = 0.02). The respective areas under the curve (AUC) for NGAL, resistin and procalcitonin in predicting SBI were 0.79, 0.80 and 0.86, whilst a combination of NGAL, resistin and procalcitonin achieved an AUC of 0.90. Conclusions: We have demonstrated a unique combination of diagnostic biomarkers of SBI using transcriptomics, and demonstrated translational concordance with the corresponding protein. The addition of NGAL and resistin protein measurement to procalcitonin significantly improved the diagnosis of SBI.

Original languageEnglish
Article number13
JournalBMC Medical Genomics
Publication statusPublished - 2012

Bibliographical note

Funding Information:
This work was supported by a Wellcome Trust Career Development Grant [Grant No. 068026] to EDC; National Institute for Health Research grant [RC-PG-0309-10053] to EDC provided support for ADI. The Malawi-Liverpool-Wellcome Trust Clinical Research Programme is supported by the Wellcome Trust. The funding bodies had no role in collection, analysis or interpretation of data or in writing the manuscript.


  • Bacterial infection
  • Biology
  • Biomarker
  • Diagnosis
  • Neutrophil-associated gelatinase
  • Procalcitonin
  • Protein
  • Resistin
  • Transcriptomics


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