| Since marked controversies exist regarding the optimal diagnosis and treatment modality of vesicoureteral reflux (VUR), I aimed to construct a risk prediction instrument that stratifies patients with VUR to different risk groups according to the two-year probability of having a breakthrough UTI (BTUTI). This instrument will provide physicians and parents with guidance for the optimal management strategy on a more individualized basis.;Clinical information (age at presentation, gender, ethnicity, VUR grade, laterality, initial presentation, and presence of bladder or bowel dysfunction [BBD]) in children diagnosed with primary VUR and followed for two years was collected. Logistic regression analysis was performed to identify factors associated with BTUTI. A probability estimate was computed for each subject using regression model coefficients and was subsequently evaluated using a receiver operating characteristic (ROC) curve low, intermediate, and high-risk groups were constructed. The model was then validated in a prospective cohort.;The retrospective cohort included 252 patients. We found high grade VUR (IV-V), as well as initial presentation due to UTI and female gender to be important risk factors for BTUTI (OR=9.4, p<0.001, OR=5.3, p=0.034, OR=2.6, p=0.054 respectively). Absence of BBD was a significant protecting factor in patients with low grade VUR (OR=2.8, p=0.018). Patients were stratified into three distinctive risk groups. The overall ROC, AUC of the probability estimate was good (AUC=0.76). The probability model was then validated on a prospective cohort and demonstrated good ROC accuracy (AUC=0.80).;This proposed risk stratification and probability model allows the clinician to predict the patient's specific two-year risk of having BTUTI on a more individualized basis and to optimize the treatment strategy accordingly. |
