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[Predictors of perioperative complications in children with obstructive uropathy]
O L Morozova1,2, D A Morozov1,2, D Y Lakomova1,2
1Sechenov First Moscow State Medical University, Moscow, Russia.
Insights
Cytokines like IL-8 and IL-10 indicate latent inflammation in children with obstructive uropathy (OU). These cytokine levels can predict potential perioperative complications, aiding in personalized patient management.
Area of Science:
- Pediatric Urology
- Inflammatory Cytokines
- Surgical Complications
Background:
- Obstructive uropathy (OU) in children can lead to significant health issues.
- Predicting perioperative complications is crucial for effective management.
- Inflammatory markers may offer insights into disease activity and risk.
Purpose of the Study:
- To identify predictors of perioperative complications in pediatric obstructive uropathy.
- To evaluate the role of pro- and anti-inflammatory cytokines in children with OU.
- To develop a model for predicting complications and personalizing patient care.
Main Methods:
- 178 children with obstructive uropathy were studied, categorized by condition (hydronephrosis, ureterohydronephrosis, bladder outlet obstruction).
- Urine levels of Interleukin-8 (IL-8) and Interleukin-10 (IL-10) were measured pre- and post-surgery.
- An Index of Inflammation Activity (IIA) was derived from cytokine ratios.
Main Results:
- Chronic pyelonephritis was prevalent, especially in bladder outlet obstruction cases (100%).
- Escherichia coli was the primary pathogen identified.
- Elevated IL-8 and IL-10 levels correlated with active and latent inflammation, respectively, and were higher pre- and post-surgery.
- The developed Index of Inflammation Activity (IIA) showed increased values and was used to create a predictive model for complications.
Conclusions:
- Cytokines, specifically IL-8 and IL-10, serve as indicators of latent inflammation in pediatric obstructive uropathy.
- These cytokine levels are valuable predictors of perioperative complications.
- The findings support the development of algorithms for personalized patient management in pediatric OU.
Aim:
To identify predictors of perioperative complications in children with obstructive uropathy.
Materials And Methods:
A total of 178 patients with obstructive uropathy were divided into 3 groups. In Group 1 there were 108 children with hydronephrosis, while Group 2 included 47 children with ureterohydronephrosis and Group 3 consisted of 23 children with bladder outlet obstruction according to the results of clinical, laboratory, microbiological, X-ray and pathologic study. The evaluation of the urine level of pro- (IL-8) and anti-inflammatory (IL-10) cytokines was performed at two timepoints, prior to treatment (1 point) and on the 3-5th day after the surgery (2 point) using "Vector - Best" (Russia, Novosibirsk) (IL-8), "Bender Medsystems" (Austria) (IL-10) on the enzyme immunoassay analyzer Stat Fax 2010 (USA).
Results:
The active phase of chronic pyelonephritis was shown in Groups 1, 2 and 3 in 38%, 36% and 100% of cases, respectively. Microbiological examination of urine allowed to identify a causative agent in 85% and 89% of biopsy specimens from the ureteropelvic and ureterovesical junction, respectively. In all groups, Escherichia coli was a main pathogen (40%). In 25% of patients of Groups 1 and 2, isolated pathogens in biopsy specimen and urine were different. According to the evaluation of cytokines in the urine, during the active phase of chronic pyelonephritis there was an increase in the level of IL8 (p<0.0001) at points 1 and 2 in all patients. In the latent phase of inflammation, there was an increase in the concentration of IL-8 (p<0.04) and IL-10 (p<0.002) at point 2 in Groups 1 and 2. Using the ratio of IL-8 and IL-10, an index of inflammation activity (IIA) was suggested, whose values were increased in all Groups at point 1 and 2. Based on the regression analysis of the changes in IIA level, a model for predicting perioperative complications and an algorithm for personalized patient management were developed.
Conclusion:
Cytokines are indicators of latent inflammation in children with OU and may be predictors of perioperative complications.
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