Diagnostic value of urinary system ultrasound combined with procalcitonin for high-grade vesicoureteral reflux in children

doi:10.3877/cma.j.issn.2095-655X.2024.03.002

Abstract

Abstract:

Objective

To investigate the diagnostic value of renal and bladder ultrasonography (RBUS) combined with procalcitonin (PCT) in children with high-grade vesicoureteral reflux (VUR).

Methods

A total of 81 children diagnosed with urinary tract infection (UTI) for the first time in the Department of Pediatrics of the Affiliated Hospital of Inner Mongolia Medical University from December 2019 to December 2023 were selected. RBUS and the results of PCT within 24 h after treatment were recorded, and contrast-enhanced voiding urosonography (CeVUS) examination was performed. The CeVUS results were used as the grading standard for VUR. There were 43 cases in the no-reflux group, 27 cases in the low-grade reflux group (grade Ⅰ-Ⅲ), and 11 cases in the high-grade reflux group (grade Ⅳ-Ⅴ). Binary Logistic regression was used to analyze the influencing factors of high and low VUR. Receiver operating characteristic (ROC) curve was used to predict VUR, and Delong′s algorithm was used to compare the area under the curve.

Results

Pyelodissociation, hydronephrosis and ureteral dilation were independent risk factors for VUR (OR=4.624, 5.777, 10.460, all P<0.05). Hydronephrosis, ureteral dilation and high PCT level were independent risk factors for high-grade VUR (OR=40.037, 45.367, 1.572, all P<0.05). The optimal cut-off value for PCT prediction of high-grade VUR was 3.42 μg/L, and the area under ROC curve was 0.848 (95%CI: 0.706-0.985). The diagnostic accuracy of PCT and RBUS abnormality was 0.953 (95%CI: 0.830-0.995).

Conclusions

RBUS abnormalities such as hydronephrosis and ureteral dilation are associated with high-grade VUR. PCT is related to the severity of VUR in children with UTI. PCT combined with RBUS abnormal indicators has a high diagnostic accuracy, and can be a convenient and quick preliminary screening method for clinical diagnosis of VUR.

Key words: Vesicoureteric reflux, Ultrasonography, Procalcitonin, Urinary tract infection, Children

Nuo Yan, Wei Deng, Yingxia Zhang, Danyang He, Ning Fan. Diagnostic value of urinary system ultrasound combined with procalcitonin for high-grade vesicoureteral reflux in children[J]. Chinese Journal of Diagnostics(Electronic Edition), 2024, 12(03): 149-154.

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References 19

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项目	无反流组(n＝43)	低级别VUR组(n＝27)	高级别VUR组(n＝11)
肾盂分离	11	16	6
肾积水	3	6	5
输尿管扩张	2	4	8
肾脏回声增强	0	3	3
肾脏发育异常	0	1	2
膀胱壁增厚	0	1	0

项目	无反流组(n＝43)	低级别VUR组(n＝27)	高级别VUR组(n＝11)
肾盂分离	11	16	6
肾积水	3	6	5
输尿管扩张	2	4	8
肾脏回声增强	0	3	3
肾脏发育异常	0	1	2
膀胱壁增厚	0	1	0

项目	无反流组(n＝43)	VUR组(n＝38)	χ²值	P值
肾盂分离	11(25.58)	22(57.89)	8.73	0.003
肾积水	3(6.98)	11(28.95)	5.36	0.021^a
输尿管扩张	2(4.65)	12(31.58)	8.44	0.004^a
肾脏回声增强	0	6(15.79)	－	0.009^b
肾脏发育异常	0	3(7.89)	－	0.099^b
膀胱壁增厚	0	1(2.63)	－	0.469^b

项目	无反流组(n＝43)	VUR组(n＝38)	χ²值	P值
肾盂分离	11(25.58)	22(57.89)	8.73	0.003
肾积水	3(6.98)	11(28.95)	5.36	0.021^a
输尿管扩张	2(4.65)	12(31.58)	8.44	0.004^a
肾脏回声增强	0	6(15.79)	－	0.009^b
肾脏发育异常	0	3(7.89)	－	0.099^b
膀胱壁增厚	0	1(2.63)	－	0.469^b

项目	B	S.E	Wald χ²值	P值	OR值	95%CI
项目	B	S.E	Wald χ²值	P值	OR值	下限	上限
肾脏回声增强	－0.597	1.225	0.237	0.626	0.551	0.050	6.074
膀胱壁增厚	0.206	0.825	0.062	0.803	1.229	0.244	6.193
肾脏发育异常	－0.404	0.931	0.188	0.665	0.668	0.108	4.144
肾盂分离	1.531	0.593	6.666	0.010	4.624	1.446	14.784
肾积水	1.754	0.880	3.976	0.046	5.777	1.030	32.390
输尿管扩张	2.348	0.994	5.577	0.018	10.460	1.491	73.398
常量	－2.850	1.330	4.588	0.032	0.058

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