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Predicting the Risk of Breakthrough Urinary Tract Infections: Primary Vesicoureteral Reflux.

Publication ,  Journal Article
Hidas, G; Billimek, J; Nam, A; Soltani, T; Kelly, MS; Selby, B; Dorgalli, C; Wehbi, E; McAleer, I; McLorie, G; Greenfield, S; Kaplan, SH; Khoury, AE
Published in: The Journal of urology
November 2015

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.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.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.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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Published In

The Journal of urology

DOI

EISSN

1527-3792

ISSN

0022-5347

Publication Date

November 2015

Volume

194

Issue

5

Start / End Page

1396 / 1401

Related Subject Headings

  • Vesico-Ureteral Reflux
  • Urology & Nephrology
  • Urinary Tract Infections
  • Urinalysis
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Prospective Studies
  • Prognosis
  • Male
 

Citation

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Chicago
ICMJE
MLA
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Hidas, G., Billimek, J., Nam, A., Soltani, T., Kelly, M. S., Selby, B., … Khoury, A. E. (2015). Predicting the Risk of Breakthrough Urinary Tract Infections: Primary Vesicoureteral Reflux. The Journal of Urology, 194(5), 1396–1401. https://doi.org/10.1016/j.juro.2015.06.019
Hidas, Guy, John Billimek, Alexander Nam, Tandis Soltani, Maryellen S. Kelly, Blake Selby, Crystal Dorgalli, et al. “Predicting the Risk of Breakthrough Urinary Tract Infections: Primary Vesicoureteral Reflux.The Journal of Urology 194, no. 5 (November 2015): 1396–1401. https://doi.org/10.1016/j.juro.2015.06.019.
Hidas G, Billimek J, Nam A, Soltani T, Kelly MS, Selby B, et al. Predicting the Risk of Breakthrough Urinary Tract Infections: Primary Vesicoureteral Reflux. The Journal of urology. 2015 Nov;194(5):1396–401.
Hidas, Guy, et al. “Predicting the Risk of Breakthrough Urinary Tract Infections: Primary Vesicoureteral Reflux.The Journal of Urology, vol. 194, no. 5, Nov. 2015, pp. 1396–401. Epmc, doi:10.1016/j.juro.2015.06.019.
Hidas G, Billimek J, Nam A, Soltani T, Kelly MS, Selby B, Dorgalli C, Wehbi E, McAleer I, McLorie G, Greenfield S, Kaplan SH, Khoury AE. Predicting the Risk of Breakthrough Urinary Tract Infections: Primary Vesicoureteral Reflux. The Journal of urology. 2015 Nov;194(5):1396–1401.
Journal cover image

Published In

The Journal of urology

DOI

EISSN

1527-3792

ISSN

0022-5347

Publication Date

November 2015

Volume

194

Issue

5

Start / End Page

1396 / 1401

Related Subject Headings

  • Vesico-Ureteral Reflux
  • Urology & Nephrology
  • Urinary Tract Infections
  • Urinalysis
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Prospective Studies
  • Prognosis
  • Male