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Predictors of grade 3-5 vesicoureteral reflux in infants ≤ 2 months of age with pyelonephritis.
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2018-12-26 , DOI: 10.1007/s00467-018-4167-0
Hilla Bahat 1, 2 , Mai Ben-Ari 1 , Tomer Ziv-Baran 2, 3 , Amos Neheman 2, 4 , Ilan Youngster 1, 2 , Michael Goldman 1, 2
Affiliation  

BACKGROUND This study aimed to assess predictors for grade 3-5 vesicoureteral reflux (VUR) in infants ≤ 2 months of age admitted for first urinary tract infection (UTI). METHODS Retrospective cohort study of 195 infants ≤ 2 months admitted to a pediatric ward for first UTI between 2006 and 2017. Clinical, laboratory, and imaging data were collected from electronic medical charts. We examined associations between grade 3-5 VUR and different patient characteristics. RESULTS Twenty infants (10%) were diagnosed with grade 3-5 VUR; all had fever. Infants with grade 3-5 VUR had higher blood neutrophil percentage (BNP) (65% vs. 46%, P < 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (2.6 vs. 1.3, P < 0.001), more renal ultrasound abnormalities (prenatal 26% vs. 5%, P = 0.007; postnatal 84% vs. 55%, P = 0.015), and Pseudomonas UTI (15% vs. 1%, respectively, P < 0.001). NLR > 1.65 showed sensitivity 100% and specificity 61% for detecting grade 3-5 VUR. BNP > 53% showed sensitivity 100% and specificity 60% for detecting grade 3-5 VUR. BNP was the best single marker for grade 3-5 VUR with area under the curve (AUC) of 0.82 (95% CI 0.75-0.89). In a multivariate model, AUC for combination of BNP and hydronephrosis was 0.86 (95% CI 0.79-0.93, P = 0.007). CONCLUSIONS Infants ≤ 2 months of age admitted for a first UTI are at risk for grade 3-5 VUR and thus should undergo a voiding cystourethrography (VCUG) if their renal ultrasound is abnormal or if they have Pseudomonas UTI. Avoiding VCUG can be considered in afebrile infants and in infants with BNP < 53% or NLR < 1.65.

中文翻译:

≤2个月大的肾盂肾炎的3-5级膀胱输尿管反流的预测指标。

背景技术本研究旨在评估首次尿路感染(UTI)≤2个月的婴儿3-5级膀胱输尿管反流(VUR)的预测指标。方法回顾性队列研究于2006年至2017年期间对195例≤2个月的儿科病房进行首次UTI入院的婴儿。临床,实验室和影像学数据均来自电子病历。我们检查了3-5级VUR与不同患者特征之间的关联。结果20例婴儿(10%)被诊断出3-5级VUR。都发烧了。3-5级VUR的婴儿具有更高的血液中性粒细胞百分比(BNP)(65%比46%,P <0.001),更高的中性粒细胞与淋巴细胞比(NLR)(2.6 vs. 1.3,P <0.001),更多肾超声异常(产前26%vs. 5%,P = 0.007;产后84%vs. 55%,P = 0.015)和假单胞菌UTI(15%vs. 1%,分别为P <0.001)。NLR> 1.65表示检测3-5级VUR的敏感性为100%,特异性为61%。BNP> 53%表示检测3-5级VUR的敏感性为100%,特异性为60%。BNP是3-5级VUR的最佳单一标记,曲线下面积(AUC)为0.82(95%CI 0.75-0.89)。在多变量模型中,BNP和肾积水合并的AUC为0.86(95%CI 0.79-0.93,P = 0.007)。结论首次接受UTI的≤2个月的婴儿处于3-5 VUR的风险中,因此,如果他们的肾脏超声异常或患有假单胞菌UTI,则应行排尿膀胱尿道造影(VCUG)。高热婴儿和BNP <53%或NLR <1.65的婴儿可以考虑避免使用VCUG。65检测3-5级VUR的灵敏度为100%,特异性为61%。BNP> 53%表示检测3-5级VUR的敏感性为100%,特异性为60%。BNP是3-5级VUR的最佳单一标记,曲线下面积(AUC)为0.82(95%CI 0.75-0.89)。在多变量模型中,BNP和肾积水合并的AUC为0.86(95%CI 0.79-0.93,P = 0.007)。结论首次接受UTI的≤2个月的婴儿处于3-5 VUR的风险中,因此,如果他们的肾脏超声异常或患有假单胞菌UTI,则应行排尿膀胱尿道造影(VCUG)。高热婴儿和BNP <53%或NLR <1.65的婴儿可以考虑避免使用VCUG。65检测3-5级VUR的敏感性为100%,特异性为61%。BNP> 53%表示检测3-5级VUR的敏感性为100%,特异性为60%。BNP是3-5级VUR的最佳单一标记,曲线下面积(AUC)为0.82(95%CI 0.75-0.89)。在多变量模型中,BNP和肾积水合并的AUC为0.86(95%CI 0.79-0.93,P = 0.007)。结论首次接受UTI的≤2个月的婴儿处于3-5 VUR的风险中,因此,如果他们的肾脏超声异常或患有假单胞菌UTI,则应行排尿膀胱尿道造影(VCUG)。高热婴儿和BNP <53%或NLR <1.65的婴儿可以考虑避免使用VCUG。BNP是3-5级VUR的最佳单一标记,曲线下面积(AUC)为0.82(95%CI 0.75-0.89)。在多变量模型中,BNP和肾积水合并的AUC为0.86(95%CI 0.79-0.93,P = 0.007)。结论首次接受UTI的≤2个月的婴儿处于3-5 VUR的风险中,因此,如果他们的肾脏超声异常或患有假单胞菌UTI,则应行排尿膀胱尿道造影(VCUG)。高热婴儿和BNP <53%或NLR <1.65的婴儿可以考虑避免使用VCUG。BNP是3-5级VUR的最佳单一标记,曲线下面积(AUC)为0.82(95%CI 0.75-0.89)。在多变量模型中,BNP和肾积水合并的AUC为0.86(95%CI 0.79-0.93,P = 0.007)。结论首次接受UTI的≤2个月的婴儿处于3-5 VUR的风险中,因此,如果他们的肾脏超声异常或患有假单胞菌UTI,则应行排尿膀胱尿道造影(VCUG)。高热婴儿和BNP <53%或NLR <1.65的婴儿可以考虑避免使用VCUG。结论首次接受UTI的≤2个月的婴儿处于3-5 VUR的风险中,因此,如果他们的肾脏超声异常或患有假单胞菌UTI,则应行排尿膀胱尿道造影(VCUG)。高热婴儿和BNP <53%或NLR <1.65的婴儿可以考虑避免使用VCUG。结论初次接受UTI的≤2个月的婴儿有3-5 VUR的风险,因此,如果他们的肾脏超声异常或患有假单胞菌UTI,则应行排尿膀胱尿道造影(VCUG)。高热婴儿和BNP <53%或NLR <1.65的婴儿可以考虑避免使用VCUG。
更新日期:2019-11-01
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