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Development of visual scoring system with Tc-99m DMSA renal scintigraphy to predict the risk of recurrence of symptomatic urinary tract infections in pediatric patients

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Abstract

Objective

Vesicoureteral reflux (VUR) is a major risk factor for recurrent symptomatic urinary tract infection (UTI) in pediatric patients. In addition, dimercaptosuccinic acid renal scintigraphy (DMSA) is an important diagnostic modality of VUR. However, the value of DMSA for predicting recurrent pediatric UTI has not been studied. Therefore, we aimed to develop visual scoring system (VSS) with DMSA to predict the risk of recurrence of symptomatic urinary tract infection in pediatric patient under the age of 24 months.

Methods

Pediatric UTI patients who visited our tertiary hospital emergency department and underwent DMSA for initial work-up from January 2006 to December 2014 were reviewed retrospectively. We developed a VSS with Tc-99m DMSA renal scintigraphy. We compared sensitivity and specificity between VSS with DMSA and other variables in predicting recurrent symptomatic UTI. Laboratory indices for systemic inflammation, abnormal finding on ultrasonography, VUR on voiding cystourethrogram (VCUG), and the VSS with DMSA were considered as variables. In addition, we used Kaplan–Meier estimator analyses and Cox proportional regression analyses to evaluate the predictive value of each variable for the recurrence of symptomatic UTI.

Results

A total of 338 patients were enrolled. During the follow-up period, 42 patients (12.4%) had UTI recurrence. Visual scoring with DMSA resulted in 69.1% sensitivity and 79.4% specificity with an optimal cut-off value of score 2 (AUC = 0.790, p < 0.001). Significant predictive factors associated with recurrent symptomatic UTI were CRP ≥ 67.0 mg/L, VUR on VCUG and VSS with DMSA ≥ score 2. On multivariate analysis, the visual score with DMSA was the only independent prognostic factor for recurrent symptomatic UTI (p < 0.001; adjusted hazard ratio = 7.522; 95% CI = 2.799–20.224).

Conclusion

High scores in VSS with DMSA were associated with frequent recurrence and short recurrence periods in pediatric UTI patients. VSS with DMSA can stratify risk of recurrence in pediatric UTI patients.

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References

  1. Rushton HG. Urinary tract infections in children: epidemiology, evaluation, and management. Pediatr Clin North Am. 1997;44:1133–69.

    Article  CAS  PubMed  Google Scholar 

  2. Ammenti A, Cataldi L, Chimenz R, Fanos V, La Manna A, Marra G, et al. Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta Paediatr. 2012;101:451–7.

    Article  PubMed  Google Scholar 

  3. Representatives L. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics. 1999;103:843–52.

    Article  Google Scholar 

  4. Merrick MV, Notghi A, Chalmers N, Wilkinson AG, Uttley WS. Long-term follow up to determine the prognostic value of imaging after urinary tract infections. Part 1: Reflux. Arch Dis Child. 1995;72:388–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Copp HL, Shapiro DJ, Hersh AL. National ambulatory antibiotic prescribing patterns for pediatric urinary tract infection, 1998–2007. Pediatrics. 2011;127:1027–33.

    Article  PubMed  PubMed Central  Google Scholar 

  6. van der Starre WE, Zunder SM, Vollaard AM, van Nieuwkoop C, Stalenhoef JE, Delfos NM, et al. Prognostic value of pro-adrenomedullin, procalcitonin and C-reactive protein in predicting outcome of febrile urinary tract infection. Clin Microbiol Infect. 2014;20:1048–54.

    Article  CAS  PubMed  Google Scholar 

  7. Han SY, Lee IR, Park SJ, Kim JH, Shin JI. Usefulness of neutrophil–lymphocyte ratio in young children with febrile urinary tract infection. Korean J Pediatr. 2016;59:139–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hamiel U, Bahat H, Kozer E, Hamiel Y, Ziv-Baran T, Goldman M. Diagnostic markers of acute infections in infants aged 1 week to 3 months: a retrospective cohort study. BMJ Open. 2018;8:e018092.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Turkmen K, Erdur FM, Ozcicek F, Ozcicek A, Akbas EM, Ozbicer A, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013;17:391–6.

    Article  PubMed  Google Scholar 

  10. Ki HC, Kim S-O, Yoo DH, Hwang IS, Hwang EC, Oh KJ, et al. Abnormal dimercaptosuccinic acid scan may be related to persistence of vesicoureteral reflux in children with febrile urinary tract infection. Korean J Urol. 2012;53:716–20.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lee JH, Kim MK, Park SE. Is a routine voiding cystourethrogram necessary in children after the first febrile urinary tract infection? Acta Paediatr. 2012;101:e105–9.

    Article  PubMed  Google Scholar 

  12. Lassmann M, Treves ST, Group ESPDHW. Paediatric radiopharmaceutical administration: harmonization of the 2007 EANM paediatric dosage card (version 1.5. 2008) and the 2010 North American consensus guidelines. Eur J Nucl Med Mol Imaging. 2014;41:1036–41.

    Article  CAS  PubMed  Google Scholar 

  13. Jakobsson B, Jacobson S, Hjälmås K. Vesico-ureteric reflux and other risk factors for renal damage: identification of high-and low-risk children. Acta Paediatr. 1999;88:31–9.

    Article  CAS  Google Scholar 

  14. Smellie J, Poulton A, Prescod N. Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ. 1994;308:1193–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Camacho V, Estorch M, Fraga G, Mena E, Fuertes J, Hernández MA, et al. DMSA study performed during febrile urinary tract infection: a predictor of patient outcome? Eur J Nucl Med Mol Imaging. 2004;31:862–6.

    Article  CAS  PubMed  Google Scholar 

  16. Biggi A, Dardanelli L, Cussino P, Pomero G, Noello C, Sernia O, et al. Prognostic value of the acute DMSA in children with first urinary tract infection. Pediatr Nephrol. 2001;16:800–4.

    Article  CAS  PubMed  Google Scholar 

  17. Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128:595–610.

    Article  PubMed  Google Scholar 

  18. Mori R, Lakhanpaul M, Verrier-Jones K. Diagnosis and management of urinary tract infection in children: summary of NICE guidance. BMJ. 2007;335:395–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lee SJ. Clinical guideline for childhood urinary tract infection (second revision). Child Kidney Dis. 2015;19:56–64.

    Article  Google Scholar 

  20. Risdon RA, Godley ML, Parkhouse HF, Gordon I, Ransley PG. Renal pathology and the 99mTc-DMSA image during the evolution of the early pyelonephritic scar: an experimental study. J Urol. 1994;151:767–73.

    Article  CAS  PubMed  Google Scholar 

  21. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102:5–14.

    CAS  PubMed  Google Scholar 

  22. de Jager CPC, van Wijk PTL, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14:R192.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Balta S, Ozturk C. The platelet-lymphocyte ratio: a simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26:680–1.

    Article  CAS  PubMed  Google Scholar 

  24. Uzun F, Erturk M, Cakmak HA, Kalkan AK, Akturk IF, Yalcin AA, et al. Usefulness of the platelet-to-lymphocyte ratio in predicting long-term cardiovascular mortality in patients with peripheral arterial occlusive disease. Postepy Kardiol Interwencyjnej. 2017;13:32–8.

    PubMed  PubMed Central  Google Scholar 

  25. Miglani RK, Bhateja N, Bhat RS, Kumar KV. Diagnostic role of platelet lymphocyte ratio (PLR) in pancreatic head masses. Indian J Surg. 2013;75:4–9.

    Article  PubMed  Google Scholar 

  26. Alexandrakis MG, Passam FH, Moschandrea IA, Christophoridou AV, Pappa CA, Coulocheri SA, et al. Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol. 2003;26:135–40.

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by the National Research Foundation (NRF) funded by the Ministry of Education of South Korea (2018R1D1A1B07049400: Hai-Jeon Yoon and 2017R1D1A1B03035305: Daehee Kim) and the Grant of Translational R&D Project through Institute for Bio-Medical convergence, Incheon St. Mary’s Hospital, The Catholic University of Korea (IBC2018-06: Woon Jeong Lee).

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Author notes

  1. Hai-Jeon Yoon and Seon Hee Woo contributed equally to this work.

Authors and Affiliations

  1. Department Emergency Medicine, Incheon St. Maryʼs Hospital, The Catholic University of Korea, Incheon, South Korea

    Daehee Kim

  2. Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea

    Hai-Jeon Yoon & Bom Sahn Kim

  3. Department Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Seon Hee Woo & Woon Jeong Lee

  4. Department of Radiology, Incheon St. Maryʼs Hospital, The Catholic University of Korea, Incheon, South Korea

    Yong An Chung & Jin Kyoung Oh

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  1. Daehee Kim
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Correspondence to Hai-Jeon Yoon or Seon Hee Woo.

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Kim, D., Yoon, HJ., Woo, S.H. et al. Development of visual scoring system with Tc-99m DMSA renal scintigraphy to predict the risk of recurrence of symptomatic urinary tract infections in pediatric patients. Ann Nucl Med 33, 708–715 (2019). https://doi.org/10.1007/s12149-019-01379-0

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  • DOI: https://doi.org/10.1007/s12149-019-01379-0

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