Purpose: Since marked controversies exist regarding the optimal diagnosis and treatment modality of Vesicoureteral Reflux(VUR), we aimed to construct a risk prediction instrument that stratifies patients with primary VUR to different risk groups according to the two-year probability of having a breakthrough urinary tract infection(BTUTI).
Materials & Methods: Demographic and clinical information were collected on children diagnosed with VUR, and followed for two years. Binary logistic regression analysis was performed to identify factors associated with BTUTI. Low, intermediate, and high-risk groups were constructed according to these risk factors. The model was subsequently validated in a prospective cohort.
Results: The retrospective cohort included 252 patients. We found that high grade VUR(IV-V)(OR 9.4;95%CI 3.8-23.5p<0.001), initial presentation due to UTI(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 BTUTI. Subgroup analysis showed that Bowel and bladder dysfunction(BBD) was a significant risk factor for BTUTI in the patient with low grade VUR(I-III)(OR 2.8 for BBD,p= 0.018) but not in the high-grade VUR(IV-V)(p=0.5). We stratified patients into three distinct risk groups based on the parameters included in the risk model and found significant discrimination(Table). Applied to a prospective validation sample(N=56), showed good performance as a discriminator of subsequent BTUTI.
Conclusion: Two-year incidence rate for BTUTI was significantly different between low, intermediate, and high-risk groups. This instrument may provide physicians and parents guidance to determine the optimal management strategy on a more individualized basis.
