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Predicting Breakthrough Urinary Tract Infection: Comparative Analysis of Vesicoureteral Reflux Index, Reflux Grade

Angela M Arlen1, Traci Leong2, Charlotte Q Wu3

  • 1Department of Urology, Yale University School of Medicine, New Haven, Connecticut.

The Journal of Urology
|April 4, 2020
PubMed

Insights

The vesicoureteral reflux index effectively predicts breakthrough febrile urinary tract infections in children. This index offers valuable prognostic information for better clinical decisions regarding infection risk.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Infectious Diseases

Background:

  • Vesicoureteral reflux (VUR) is a common condition in children.
  • Identifying children at risk for febrile urinary tract infections (fUTIs) is crucial for management.
  • The vesicoureteral reflux index (VURi) is a validated tool for predicting VUR resolution.

Purpose of the Study:

  • To evaluate the vesicoureteral reflux index (VURi) as a predictor of breakthrough fUTIs.
  • To compare the predictive performance of VURi against reflux grade and distal ureteral diameter ratio.

Main Methods:

  • Retrospective analysis of children with primary VUR and voiding cystourethrogram data.
  • Calculation of VURi and ureteral diameter ratio.
  • Use of random forest modeling and logistic regression to assess predictive accuracy for fUTIs.

Main Results:

  • 9.4% of analyzed children experienced breakthrough fUTIs.
  • VURi (AUC=0.77) and ureteral diameter ratio (AUC=0.71) were significant predictors of fUTIs.
  • Reflux grade did not reach statistical significance (p=0.09).

Conclusions:

  • Higher vesicoureteral reflux index is associated with increased risk of breakthrough fUTIs, independent of reflux grade.
  • VURi offers valuable prognostic information for infection risk in children with VUR.
  • The VURi can aid in improved clinical decision-making for managing pediatric VUR.
Abstract

Keywords:
cystographyurinary tract infectionsvesico-ureteral reflux

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