Development of a prediction model for risk of breakthrough urinary tract infection in children with primary vesicoureteral reflux.

IF 1.7 3区医学 Q4 ANDROLOGY

Translational andrology and urology Pub Date : 2025-07-30 Epub Date: 2025-07-28 DOI:10.21037/tau-2025-85

Zhenzhen Yang, Jiayi Li, Pei Liu, Ning Sun, Hongcheng Song, Weiping Zhang

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引用次数: 0

Abstract

Background: Many factors influence the risk of breakthrough urinary tract infection (BTUTI) in children with primary vesicoureteral reflux (VUR). Distal ureteral diameter ratio (UDR) and VUR index (VURx) have been shown in studies as predictors of BTUTI. We aimed to establish a predictive model through selecting voiding cystourethrography (VCUG)-related parameters in combination with clinical parameters for BTUTI in children with primary VUR.

Methods: A retrospective cohort analysis was conducted on the clinical characteristics and VCUG-related parameters of patients with primary VUR. Univariable and multivariable analyses were performed to identify independent predictors and develop a model for predicting the probability of BTUTI. We compared our model against two other metrics for predicting BTUTI: the distal UDR and the VURx. The area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the predictive performance of the model.

Results: A total of 193 patients were included in this study. Based on the results of univariable and multivariable analyses, three variables of sex (female) [odds ratio (OR): 3.39; 95% confidence interval (CI): 1.57-7.33], high-grade VUR (OR: 2.27; 95% CI: 0.98-5.25), and ureterovesical junction diameter of ureter (UVJ diameter) (OR: 5.85; 95% CI: 1.81-18.92) were used to create a prediction model and a nomogram. The AUCs for our model, the UDR, and the VURx in predicting the occurrence of BTUTI were 0.736, 0.680, and 0.546, respectively. The DCA revealed the clinical usefulness of the model.

Conclusions: This study identified three independent variables, namely, female sex, high-grade VUR, and UVJ diameter, for predicting the probability of BTUTI in primary VUR. The model and nomogram established in this study can greatly assist urologists in individualizing the management of primary VUR patients.

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原发性膀胱输尿管反流患儿突破性尿路感染风险预测模型的建立

背景：影响原发性膀胱输尿管反流（VUR）患儿发生突破性尿路感染（BTUTI）风险的因素很多。研究表明，远端输尿管直径比（UDR）和VUR指数（VURx）可作为BTUTI的预测指标。我们的目的是通过选择排尿膀胱尿道造影（VCUG）相关参数并结合临床参数，建立原发性VUR患儿BTUTI的预测模型。方法：回顾性队列分析原发性VUR患者的临床特征及vug相关参数。进行单变量和多变量分析以确定独立预测因子，并建立预测BTUTI概率的模型。我们将我们的模型与预测BTUTI的其他两个指标进行了比较：远端UDR和VURx。采用受试者工作特征曲线（ROC）下面积、校正曲线和决策曲线分析（DCA）来评价模型的预测性能。结果：本研究共纳入193例患者。根据单变量和多变量分析结果，性别（女性）三个变量[比值比（OR）： 3.39；95%可信区间（CI）： 1.57-7.33]，高级别VUR (OR: 2.27；95% CI: 0.98-5.25)，输尿管输尿管膀胱连接处直径（UVJ直径）(OR: 5.85；95% CI: 1.81-18.92)建立预测模型和模态图。我们的模型、UDR和VURx预测BTUTI发生的auc分别为0.736、0.680和0.546。DCA显示了该模型的临床应用价值。结论：本研究确定了三个独立变量，即女性性别、高级别VUR和UVJ直径，用于预测原发性VUR中BTUTI的概率。本研究所建立的模型和形态图可以极大地帮助泌尿科医师对原发性VUR患者进行个体化治疗。

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来源期刊

Translational andrology and urology Medicine-Urology

CiteScore

4.10

自引率

5.00%

发文量

期刊介绍： ranslational Andrology and Urology (Print ISSN 2223-4683; Online ISSN 2223-4691; Transl Androl Urol; TAU) is an open access, peer-reviewed, bi-monthly journal (quarterly published from Mar.2012 - Dec. 2014). The main focus of the journal is to describe new findings in the field of translational research of Andrology and Urology, provides current and practical information on basic research and clinical investigations of Andrology and Urology. Specific areas of interest include, but not limited to, molecular study, pathology, biology and technical advances related to andrology and urology. Topics cover range from evaluation, prevention, diagnosis, therapy, prognosis, rehabilitation and future challenges to urology and andrology. Contributions pertinent to urology and andrology are also included from related fields such as public health, basic sciences, education, sociology, and nursing.