الفهرس 
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Abstract
Background: Fever is a common problem in adult patients admitted to ICUs. However, fever is most frequently due to infections but there are many noninfectious causes as blood transfusions reactions. Empiric broad-spectrum antibiotic therapy is widely used to manage fever in ICUs however, it is effective only in the case of bacterial infection. Intensivists need a rapid test to rule in or to rule out the bacterial infection in patients with fever in adult ICUs. The aim of the work: This study aimed to identify the role of lipocalin 2 as a sensitive and specific biomarker of bacterial infection in patients with fever at adult ICUs. Type of study: case control study. Materials and Methods: The study was performed in adult intensive care units of gastrointestinal surgery center (GISC) of Mansoura University. This study was performed on 95 subjects (75 patients and 20 healthy volunteers). All patients were in adult ICUs and suffering from fever with body temperature of 37.8° C or greater. Healthy volunteers were from blood donors to the blood bank of Mansoura University. Measurement of serum lipocalin 2 and CBC were done for all subjects. Moreover, Traditional cultures according to the site of infection were done for all patients. Blood cultures were done for most cases (73.3%), cultures from drains accounted for 17.3%, cultures from urine accounted for 4%, cultures from sputum accounted for 2.7%, cultures from wound accounted for 2.7%. Data were analyzed using SPSS (Standard version 20). P ≤ 0.05 was considered statistically significant Results: Results showed that lipocalin 2 was a sensitive (94.4%) and specific (100%) biomarker of bacterial infection in patients with fever at adult ICUs. Tumors represented about (90.7%). Most cultured samples revealed bacterial growth (72%). Older age and higher body temperature were significantly associated with cases with positive bacterial culture when compared to cases with negative bacterial culture. Median Lipocalin 2 concentration in control group was 67.4, while it was 139 in cases. Cases group showed significantly higher Lipocalin 2 concentration when compared to control group (p<0.001). Lipocalin was significantly better than TLC for discrimination between cases and control groups (p=0.002). ROC for lipocalin 2 concentration and bacterial culture was conducted for discrimination between negative and positive bacterial growth. Lipocalin 2 showed excellent AUC (AUC=0.978). At cut off value of 92.35, sensitivity was 94.4%, specificity was 100%. While TLC AUC was 0.503, which failed to discriminate between absent and present bacterial growth. Logistic regression analysis using age, gender, body temperature, laboratory data and lipocalin 2 concentration as covariates showed that older age and higher lipocalin 2 concentration were associated with risk of bacterial growth in ICU patients in Univariable analysis. However, using significant covariates into multivariable analysis revealed that higher lipocalin 2 concentration was considered as independent predictors for bacterial growth as a cause of fever in ICU patients. Conclusion: Lipocalin 2 was a sensitive (94.4%) and specific (100%) biomarker of bacterial infection in patients with fever at adult ICUs. Recommendations: Serum lipocalin 2 level can be used as a good negative test to rule out the bacterial infections in feverish patients in adult ICUs.