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Prediction of vesico-ureteric reflux in childhood urinary tract infection: a multivariate approach
R Oostenbrink1, A J van der Heijden, K G Moons
1Department of Paediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands. oostenbrink@alkg.azr.nl
Insights
A new prediction rule using age, gender, family history, C-reactive protein (CRP), and ultrasound (US) can identify children with a first urinary tract infection (UTI) who are unlikely to have vesico-ureteric reflux (VUR). This helps avoid unnecessary imaging tests.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Urinary tract infections (UTIs) are common in children.
- Vesico-ureteric reflux (VUR) is a significant risk factor for renal scarring.
- Accurate prediction of VUR is crucial for appropriate management and avoiding unnecessary investigations.
Purpose of the Study:
- To identify independent predictors of VUR in children aged 0-5 years with a first UTI.
- To assess the added diagnostic value of renal ultrasound (US) in predicting VUR.
- To develop and validate a prediction rule for VUR.
Main Methods:
- Retrospective analysis of 140 children (0-5 years) with a first UTI.
- Data collected included patient history, physical examination, laboratory results (CRP), and renal ultrasound findings.
- VUR was diagnosed using voiding cystourethrography (VCUG) and graded.
- Multivariate logistic regression and ROC analysis were used to develop a prediction model.
Main Results:
- Independent predictors for VUR included male gender, age, family history of uropathology, elevated serum CRP, and urinary tract dilatation on US.
- The prediction model achieved an ROC area of 0.78, identifying 12% of patients without VUR.
- Using a threshold of VUR grade 3 or higher, the model identified 34% of patients as VUR-absent.
Conclusions:
- A prediction rule incorporating age, gender, family history, CRP, and US findings is effective in assessing VUR probability in children with a first UTI.
- This rule can aid clinicians in deciding whether to pursue further imaging investigations.
- Prospective validation is recommended before routine clinical application.
Unlabelled:
In this study, independent predictors obtained from patient history, physical examination and laboratory results for vesico-ureteric reflux (VUR) in children of 0-5 y with a first urinary tract infection (UTI) were assessed and the added value of renal ultrasound (US) investigated. Information was collected from children visiting the paediatric outpatient department with a first proven UTI, defined as a urine monoculture with > or = 10(5) organism/ml, with clinical symptoms and possible white cell count > or = 20 per high-power field of spun fresh urine. Children with neurologic bladder dysfunction were excluded. VUR was determined by voiding cystourethrography (VCUG) and graded from I to V. The diagnostic value of predictors was judged using multivariate logistic modelling with the area under the receiver operating characteristic (ROC area). A risk score was derived based on the regression coefficients of the independent predictors in the logistic model. In 140 children (51 boys and 89 girls) VUR was diagnosed in 37. Independent predictors for VUR were male gender, age, family history for uropathology, serum C-reactive protein level (CRP) and dilatation of the urinary tract on US. The ROC area of this model was 0.78 (95% CI: 0.69-0.87). This prediction model identified 12% (95% CI: 7-18) of the patients without VUR without missing one case of VUR. If we used VUR > or = grade 3 as a threshold, the model assessed VUR to be absent in 34% (95% CI: 26-42).
Conclusion:
A prediction rule based on age, gender, family history, CRP and US results is useful in assessing the probability of VUR in the individual child with a first UTI and may help the physician to make decisions about performing additional imaging techniques. Prospective validation of the model in future patients, however, will be necessary before applying the rule in practice.
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