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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

Title
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
Authors
Kim, DaeheeYoon, Hai-JeonWoo, Seon HeeLee, Woon JeongKim, Bom SahnChung, Yong AnOh, Jin Kyoung
Ewha Authors
김범산윤혜전
SCOPUS Author ID
김범산scopus; 윤혜전scopus
Issue Date
2019
Journal Title
ANNALS OF NUCLEAR MEDICINE
ISSN
0914-7187JCR Link

1864-6433JCR Link
Citation
ANNALS OF NUCLEAR MEDICINE vol. 33, no. 9, pp. 708 - 715
Keywords
Tc-99m DMSACortical uptake decreaseUrinary tract infectionRecurrencePrognosis
Publisher
SPRINGER
Indexed
SCIE; SCOPUS WOS scopus
Document Type
Article
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.
DOI
10.1007/s12149-019-01379-0
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의과대학 > 의학과 > Journal papers
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