Changes in Clinical Presentation and Renal Outcomes among Children with Febrile Urinary Tract Infection: 2005 vs 2015.
Changes in Clinical Presentation and Renal Outcomes among Children with Febrile Urinary Tract Infection: 2005 vs 2015.
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DOI：
10.1097/ju.0000000000001597
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发表时间：
2021-06
期刊：
影响因子：
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通讯作者：
Nelson CP
中科院分区：
文献类型：
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作者：
Lee T;Varda BK;Venna A;McCarthy I;Logvinenko T;Nelson CP
最近的研究表明，在一些儿童中，排尿膀胱输尿管造影（VCUG）使用率下降和膀胱输尿管反流（VUR）诊断延迟的趋势。这种延误可能会导致更多的儿童在诊断和治疗之前反复发作发热性尿路感染（UTI）和潜在的肾损伤。在2005年和2015年两个时间段内，我们使用单一机构的横断面队列，比较了13岁及以下有发热尿路感染病史的初次VCUG患者的临床表现和肾脏结局。结果包括：1)尿路感染复发；2)有无VUR； 3) VUR分级；4)肾脏瘢痕形成。使用多变量logistic回归模型评估出现年份与复发UTI和VUR诊断结果之间的关系。对于肾脏瘢痕形成的结果，对倾向评分匹配的队列进行逻辑回归模型拟合。与2005年就诊的儿童相比，2015年就诊的儿童复发UTI的几率是2005年的3倍（OR=3.01; [95% CI: 2.18,4.16]; p<0.0001）。时间段与VUR的发生率无关（OR=0.98; [95% CI: 0.77,1.23]; p=0.85）。2015年的患者更有可能出现>3级VUR (OR=2.22; [95% CI: 1.13,4.34], p=0.02)，但>2级VUR不存在（OR=1.11; [95% CI: 0.74,1.67], p=0.60）。肾瘢痕形成在2015年就诊的儿童中更为常见（OR=2.9; [95% CI: 1.03,8.20]; p=0.04）。与2005年相比，2015年出现尿路感染后VCUG的儿童复发尿路感染和肾脏瘢痕形成的可能性增加，尽管VUR诊断的可能性相似。
Recent studies have demonstrated trends of decreasing voiding cystourethrogram (VCUG) utilization rates and delayed vesico-ureteral reflux (VUR) diagnosis in some children. It is possible that such delays could lead to more children sustaining repeated episodes of febrile urinary tract infection (UTI), and potential kidney injury, prior to diagnosis and treatment. Using single institutional, cross-sectional cohorts of patients in two time periods (2005 and 2015), we compared clinical presentation and renal outcomes among patients 13 years and younger with history of febrile UTI presenting for initial VCUG. Outcomes included 1) recurrent UTI 2) presence of VUR 3) grade of VUR, and 4) renal scarring. Associations between year of presentation and outcomes of recurrent UTI and VUR diagnosis were evaluated using multi-variable logistic regression models. For the outcome of renal scarring, a logistic regression model was fitted for propensity score matched cohorts. Compared to children presenting in 2005, those in 2015 had 3 times the odds of recurrent UTI (OR=3.01; [95% CI: 2.18,4.16]; p<0.0001). Time period was not associated with the odds of VUR (OR=0.98; [95% CI: 0.77,1.23]; p=0.85). Those in 2015 were more likely to present with VUR grade >3 (OR=2.22; [95% CI: 1.13,4.34], p=0.02) but not VUR grade>2 (OR=1.11; [95% CI: 0.74,1.67], p=0.60). Renal scarring was more common among children presenting in 2015 (OR=2.9; [95% CI: 1.03,8.20]; p=0.04). Compared to 2005, children presenting in 2015 for post-UTI VCUG have increased likelihood of recurrent UTI and renal scarring, despite similar likelihood of VUR diagnosis.