Risk calculator predicts breakthrough UTIs in reflux patients

A new study on the use of a reflux calculator, developed at Children’s Hospital of Orange County in Irvine, CA, suggests the web-based risk stratification and probability model helps to predict vesicoureteral reflux patients’ 2-year risk of breakthrough urinary tract infection (BTUTI).

Urology Times Editorial Council member Barry A. Kogan, MD, of Albany Medical Center, Albany, NY, says the model could make a good contribution to the care of these pediatric patients.

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“As we have come to realize that vesicoureteral reflux has been over-diagnosed and over-treated, we are looking for ways to identify those cases in which reflux really is important. This novel risk calculator is an excellent concept that is easy to use and helps the clinician find those children at highest risk for recurrent pyelonephritis,” said Dr. Kogan, who was not involved with creation of the model.

The authors, who published their findings online in the Journal of Urology (June 9, 2015), analyzed retrospective demographic and clinical data on 252 patients diagnosed with primary vesicoureteral reflux, who were followed for 2 years. In their analysis, they identified factors associated with BTUTI and developed a regression model to estimate each subject’s 2-year BTUTI probability. Then, they identified three risk groups and validated the model in a prospective cohort of 56 patients.

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They found that grades IV and V, or high-grade, vesicoureteral reflux; presentation after urinary tract infection; and being female were important BTUTI risk factors. Bladder and bowel dysfunction was a more pronounced risk factor in grades I through III, or low-grade, vesicoureteral reflux.

The model predicted a 19% 2-year BTUTI rate, versus the 21% actual 2-year rate. The risk model showed the 2-year BTUTI rate was 8.6% in the low-grade group; 26% in the intermediate group; and 62.5% in the high-risk cohort.

The model, called the iReflux risk calculator, can help better inform parents of potential outcomes and treatment, researchers say.

“We hope this will aid in determining optimal treatment and follow-up plans for a patient,” the authors wrote.

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