Comprehensive analysis of some risk factors in the formation of a recurrent course of urinary tract infection in children

Abstract

The aim – to study the risk factors for the formation of recurrent urinary tract infection (UTI) in children with the determination of their prognostic value, both in single-factor and multifactorial impact.Materials and methods. A total of 2 235 children aged between 1 month to 18 years with nephrological diseases were examined. To assess the risk factors for recurrent UTI in the study population, the patients were divided into groups: with recurrent UTI – 1 (n = 447), without UTI– 0 (n = 1788). 14 traits were taken from the list of studied factors: age <1 year; female gender; ARVI ≥3 episodes over 6 months; undifferentiated connective tissue disease; kidney cystic formations; hydronephrosis and other abnormalities; vesico-ureteric reflux; neurogenic bladder, enuresis; synechia, phimosis; no deworming in the last 6 months; constipation or irritable bowel syndrome; crystalluria, accumulation of salts according to ultrasound; antibacterial therapy in the next 3 months; the presence of resistant urological strains.Results. The one-factor analysis allowed to remove statistically insignificant risk factors. As a result of multivariate analysis, a multiple logistic model was developed for the personalized prediction of a recurrent UTI in a child: odds = exp (0.712 × X1+ 3.808 × X2+ 6.982 × Х6 + 2.248×X7+ 0.165 × Х8+ 0.300 × X9+ 0.200 × X10+ 0.306 × X11+ 0.196 × X12+ 0.217 × X13+ 0.440 × X14 + (-3.489)), where Xn is a variable (or factor) which equals 1 in the case of a factor, and 0 – in the absence of a factor. The mathematical model of regression showed high statistical significance and informativeness based on the results of its testing, χ2 = 161.9; P < 0.001.Conclusions. Factors such as frequent ARVI, undifferentiated connective tissue disease, kidney cystic formations did not present a risk of recurrent UTI episodes. The dominating factors in UTI recurrences were the following: female sex increased the chance of UTI in a child almost 12 times (RR = 11.898 ± 0.252 [7.255; 19.514], P < 0.001); hydronephrosis – 11 times (RR = 10.968 ± 0.419 [4.825; 24.933], P < 0.001); vesico-ureteric reflux – 8 times (8.308 ± 0.221 [5.380; 12.804], P < 0.05); age <1 year – 4 times (RR = 3.73 ± 0.165 [2.702; 5.158], P < 0.05). Other factors influenced the development of UTI only in their combined effects and increased the probability of UTI by 1.2–1.6 times (P < 0.05).