Lertdumrongluk Kanita, Lertdumrongluk Paungpaga
Department of Paediatrics, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand.
Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand.
Int J Urol. 2021 May;28(5):573-577. doi: 10.1111/iju.14515. Epub 2021 Mar 20.
To develop a simple score for predicting vesicoureteral reflux after a first febrile urinary tract infection in children.
A retrospective cohort study was conducted for a 12-year period (January 2008 to December 2019), including patients aged <72 months who underwent renal ultrasonography and voiding cystourethrography after a first febrile urinary tract infection. Patients with a history of antenatal hydronephrosis were excluded. The prediction model and score for vesicoureteral reflux were developed using multivariate logistic regression analysis.
Out of 260 patients in total (median age 4 months, 172 boys), 41 (16%) had vesicoureteral reflux. The score was based on four independent risk factors, including age >6 months (odds ratio 2.71, 95% confidence interval 1.27-5.76), presence of sepsis (odds ratio 3.44, 95% confidence interval 1.31-9.04), white blood cell count ≥15 000/mm (odds ratio 1.83, 95% confidence interval 0.88-3.8) and abnormal renal ultrasonography results (odds ratio 2.08, 95% confidence interval 1-4.31). A lower probability of vesicoureteral reflux (positive likelihood ratio = 0.66; P = 0.001) was found in the low-risk group (scores 0-2), whereas a higher probability of vesicoureteral reflux (positive likelihood ratio = 2.54; P = 0.001) was found in the high-risk group (scores 3-5). The predictive ability of the model was 70%.
The scores developed based on the patient characteristics and renal ultrasonography are useful in predicting presence of vesicoureteral reflux after a first febrile urinary tract infection in children and could guide clinicians' decisions to perform additional imaging studies.
建立一个简单的评分系统，用于预测儿童首次发热性尿路感染后膀胱输尿管反流的发生情况。
进行了一项为期12年（2008年1月至2019年12月）的回顾性队列研究，纳入年龄小于72个月、首次发热性尿路感染后接受肾脏超声检查和排尿性膀胱尿道造影的患者。排除有产前肾积水病史的患者。采用多因素逻辑回归分析建立膀胱输尿管反流的预测模型和评分系统。
总共260例患者（中位年龄4个月，172例为男孩）中，41例（16%）存在膀胱输尿管反流。该评分基于四个独立危险因素，包括年龄大于6个月（比值比2.71，95%置信区间1.27 - 5.76）、存在脓毒症（比值比3.44，95%置信区间1.31 - 9.04）、白细胞计数≥15000/mm（比值比1.83，95%置信区间0.88 - 3.8）以及肾脏超声检查结果异常（比值比2.08，95%置信区间1 - 4.31）。低风险组（评分0 - 2）膀胱输尿管反流的可能性较低（阳性似然比 = 0.66；P = 0.001），而高风险组（评分3 - 5）膀胱输尿管反流的可能性较高（阳性似然比 = 2.54；P = 0.001）。该模型的预测能力为70%。
基于患者特征和肾脏超声检查得出的评分，有助于预测儿童首次发热性尿路感染后膀胱输尿管反流的存在情况，并可指导临床医生决定是否进行额外的影像学检查。
