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Predicting the Risk of Breakthrough Urinary Tract Infections: Primary Vesicoureteral Reflux
Guy Hidas1, John Billimek2, Alexander Nam1
1Department of Urology, Children's Hospital of Orange County, Orange, California.
Insights
A new risk model predicts the 2-year chance of breakthrough urinary tract infections in children with primary vesicoureteral reflux. This tool helps stratify patients into low, intermediate, and high-risk groups for better management.
Area of Science:
- Pediatric Nephrology
- Urology
- Clinical Risk Prediction
Background:
- Primary vesicoureteral reflux (VUR) is a common condition in children, increasing the risk of urinary tract infections (UTIs).
- Accurate risk stratification is crucial for managing VUR and preventing recurrent UTIs, which can lead to kidney damage.
Purpose of the Study:
- To develop and validate a risk prediction instrument for stratifying pediatric patients with primary VUR.
- To estimate the 2-year probability of breakthrough UTIs in these patients.
Main Methods:
- Retrospective collection of demographic and clinical data from children with primary VUR.
- Bivariate and binary logistic regression analyses to identify UTI risk factors.
- Validation of the risk model in a prospective cohort.
Main Results:
- High-grade VUR (IV-V), prior UTI presentation, and female gender were significant risk factors for breakthrough UTIs.
- Bladder and bowel dysfunction emerged as a key risk factor, particularly in low-grade VUR.
- The model accurately predicted 2-year UTI risk, with identified risk groups showing distinct probabilities (8.6% low, 26.0% intermediate, 62.5% high).
Conclusions:
- The developed risk stratification model effectively predicts the 2-year risk of breakthrough UTIs in children with primary VUR.
- This tool can inform parents about potential outcomes and guide treatment strategies.
- Improved risk assessment facilitates personalized management plans for pediatric VUR patients.
Purpose:
We constructed a risk prediction instrument stratifying patients with primary vesicoureteral reflux into groups according to their 2-year probability of breakthrough urinary tract infection.
Materials And Methods:
Demographic and clinical information was retrospectively collected in children diagnosed with primary vesicoureteral reflux and followed for 2 years. Bivariate and binary logistic regression analyses were performed to identify factors associated with breakthrough urinary tract infection. The final regression model was used to compute an estimation of the 2-year probability of breakthrough urinary tract infection for each subject. Accuracy of the binary classifier for breakthrough urinary tract infection was evaluated using receiver operator curve analysis. Three distinct risk groups were identified. The model was then validated in a prospective cohort.
Results:
A total of 252 bivariate analyses showed that high grade (IV or V) vesicoureteral reflux (OR 9.4, 95% CI 3.8-23.5, p <0.001), presentation after urinary tract infection (OR 5.3, 95% CI 1.1-24.7, p = 0.034) and female gender (OR 2.6, 95% CI 0.097-7.11, p <0.054) were important risk factors for breakthrough urinary tract infection. Subgroup analysis revealed bladder and bowel dysfunction was a significant risk factor more pronounced in low grade (I to III) vesicoureteral reflux (OR 2.8, p = 0.018). The estimation model was applied for prospective validation, which demonstrated predicted vs actual 2-year breakthrough urinary tract infection rates of 19% vs 21%. Stratifying the patients into 3 risk groups based on parameters in the risk model showed 2-year risk for breakthrough urinary tract infection was 8.6%, 26.0% and 62.5% in the low, intermediate and high risk groups, respectively.
Conclusions:
This proposed risk stratification and probability model allows prediction of 2-year risk of patient breakthrough urinary tract infection to better inform parents of possible outcomes and treatment strategies.
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