Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Pediatr Neonatol. 2022 Jul;63(4):380-387. doi: 10.1016/j.pedneo.2022.03.006. Epub 2022 Apr 12.
For risk stratification and individualized treatment for children with urinary tract infection (UTI), they must be assessed for the presence of acute pyelonephritis (APN). Our study aimed to combine variables that can predict APN and establish a nomogram for clinical use.
In total, 111 children <5 years old hospitalized at Kaohsiung Veterans General Hospital for UTI were classified into APN and simple UTI groups based on a technetium-99 m dimercaptosuccinic acid scan. Their demographic, laboratory test, and renal and urinary bladder sonography (RUBS) data were compared.
Fever peak of >39 °C, serum procalcitonin (PCT) ≥ 0.52 pg/mL, C-reactive protein (CRP) ≥ 2.86 mg/dL, and abnormal RUBS findings were independent variables for predicting APN in children. The nomogram established using the aforementioned variables had an area under the receiver operating characteristic curve (AUC) of 0.89, which was higher than those of PCT and CRP alone (0.776 and 0.774, respectively).
The combination of four variables had the highest power in predicting APN in children with UTI. The established nomogram is practical for clinical use.
为了对尿路感染（UTI）患儿进行风险分层和个体化治疗，必须评估其是否患有急性肾盂肾炎（APN）。我们的研究旨在结合可预测 APN 的变量，并建立一个列线图用于临床应用。
本研究共纳入了 111 名因 UTI 而在高雄荣民总医院住院的 <5 岁儿童，根据锝-99m 二巯丁二酸扫描将其分为 APN 组和单纯 UTI 组。比较了他们的人口统计学、实验室检查以及肾脏和膀胱超声（RUBS）数据。
发热峰值>39°C、血清降钙素原（PCT）≥0.52pg/mL、C 反应蛋白（CRP）≥2.86mg/dL 和异常 RUBS 表现是预测儿童 APN 的独立变量。使用上述变量建立的列线图的受试者工作特征曲线（ROC）下面积（AUC）为 0.89，高于 PCT 和 CRP 单独使用时的 AUC（分别为 0.776 和 0.774）。
这四个变量的组合在预测 UTI 患儿的 APN 方面具有最高的效能。所建立的列线图具有实用的临床应用价值。
