Mp72-06 Predictors of Risk of Subsequent Urinary Tract Infection in a Multicenter Cohort of Patients With Primary Vesicoureteral Reflux: Preliminary Insights on Risk Prediction

You have accessJournal of UrologyPediatrics VII (MP72)1 May 2024MP72-06 PREDICTORS OF RISK OF SUBSEQUENT URINARY TRACT INFECTION IN A MULTICENTER COHORT OF PATIENTS WITH PRIMARY VESICOURETERAL REFLUX: PRELIMINARY INSIGHTS ON RISK PREDICTION Carol A. Davis-Dao, Elias J. Wehbi, Cameron Hinkel, Allen Nguyen, Sara Alshehabi, Ala'a Farkouh, Ruby Kuang, David A. Chamberlin, Kai-Wen Chuang, Heidi A. Stephany, Emily S. Blum, Joshua D. Chamberlin, Christopher S. Cooper, Andrew J. Kirsch, and Antoine E. Khoury Carol A. Davis-DaoCarol A. Davis-Dao , Elias J. WehbiElias J. Wehbi , Cameron HinkelCameron Hinkel , Allen NguyenAllen Nguyen , Sara AlshehabiSara Alshehabi , Ala'a FarkouhAla'a Farkouh , Ruby KuangRuby Kuang , David A. ChamberlinDavid A. Chamberlin , Kai-Wen ChuangKai-Wen Chuang , Heidi A. StephanyHeidi A. Stephany , Emily S. BlumEmily S. Blum , Joshua D. ChamberlinJoshua D. Chamberlin , Christopher S. CooperChristopher S. Cooper , Andrew J. KirschAndrew J. Kirsch , and Antoine E. KhouryAntoine E. Khoury View All Author Informationhttps://doi.org/10.1097/01.JU.0001009572.60675.69.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In recent years, risk stratification of patients with primary vesicoureteral reflux (VUR) has become an attractive strategy for patient management. However, little multicenter data on VUR has been gathered to study the modern VUR population. We have developed a large, multicenter cohort of patients with VUR to further study the relationships between urinary tract infection (UTI) risk factors in a diverse group of patients. METHODS: Patients with primary VUR diagnosed by voiding cystourethrogram from 2010-2021 were collected from four academic centers. Children with secondary VUR, ureterocele, multicystic dysplastic kidney, less than 3 months of follow-up or incomplete data were excluded. Primary outcome was urinary tract infection (confirmed by proper collection method, pyuria and single-organism culture) during two years of follow-up following diagnosis. Multivariable Cox regression analysis was used to estimate adjusted UTI risk. RESULTS: Among 848 patients with primary VUR, 781 were included. Median age at diagnosis was 0.58 years (IQR 0.25-2.3), median follow-up time was 1.2 years (IQR 0.95-1.55) and 33% (257/781) of patients had high grade VUR (grades IV-V). Males comprised 41% of patients (311/781) and 63% of males (196/311) were uncircumcised. A total of 140 patients (18%) developed a UTI during two years of follow-up and median age at UTI was 1.3 years (IQR 0.65-3.5). Most patients (70%) were on continuous antibiotic prophylaxis (CAP) at the initial visit; however, CAP use varied across the cohort. In multivariable Cox regression models, several key UTI risk factors were identified. The predictors of 2-year UTI risk in this cohort were: female gender (HR 3.5, 95% CI: 1.8-7.6), presence of foreskin (HR 2.2, 95% CI: 1.1-5.1), high grade VUR (HR 1.9, 95% CI: 1.4-2.7) and Hispanic ethnicity (compared with non-Hispanic whites) (HR 1.6, 95% CI: 1.03-2.4) (adjusted for CAP use). Stratified models based on age at diagnosis, gender and grade of VUR revealed UTI risk factors by sub-group. CONCLUSIONS: In a large analysis of VUR patients, females, uncircumcised males (particularly those under one year old), patients with high grade VUR and patients of Hispanic ethnicity were at highest risk of UTI development within two years of diagnosis. These preliminary findings help provide additional data on important factors to consider for risk stratification. Next steps involve refining a risk prediction model using a combination of traditional statistics and machine learning models. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1173 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Carol A. Davis-Dao More articles by this author Elias J. Wehbi More articles by this author Cameron Hinkel More articles by this author Allen Nguyen More articles by this author Sara Alshehabi More articles by this author Ala'a Farkouh More articles by this author Ruby Kuang More articles by this author David A. Chamberlin More articles by this author Kai-Wen Chuang More articles by this author Heidi A. Stephany More articles by this author Emily S. Blum More articles by this author Joshua D. Chamberlin More articles by this author Christopher S. Cooper More articles by this author Andrew J. Kirsch More articles by this author Antoine E. Khoury More articles by this author Expand All Advertisement PDF downloadLoading ...