Risk factors for concomitant positive midstream urine culture in patients presenting with symptomatic ureterolithiasis
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Risk factors for concomitant positive midstream urine culture in patients presenting with symptomatic ureterolithiasis. / Grossmann, Nico C; Schuettfort, Victor M; Betschart, Jeannine; Becker, Anton S; Hermanns, Thomas; Keller, Etienne X; Fankhauser, Christian D; Kranzbühler, Benedikt.
In: UROLITHIASIS, Vol. 50, No. 3, 06.2022, p. 293-302.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Risk factors for concomitant positive midstream urine culture in patients presenting with symptomatic ureterolithiasis
AU - Grossmann, Nico C
AU - Schuettfort, Victor M
AU - Betschart, Jeannine
AU - Becker, Anton S
AU - Hermanns, Thomas
AU - Keller, Etienne X
AU - Fankhauser, Christian D
AU - Kranzbühler, Benedikt
N1 - © 2022. The Author(s).
PY - 2022/6
Y1 - 2022/6
N2 - In patients with symptomatic ureterolithiasis, immediate treatment of concomitant urinary tract infection (UTI) may prevent sepsis. However, urine cultures require at least 24 h to confirm or exclude UTI, and therefore, clinical variables may help to identify patients who require immediate empirical broad-spectrum antibiotics and surgical intervention. Therefore, we divided a consecutive cohort of 705 patients diagnosed with symptomatic ureterolithiasis at a single institution between 2011 and 2017 into a training (80%) and a testing cohort (20%). A machine-learning-based variable selection approach was used for the fitting of a multivariable prognostic logistic regression model. The discriminatory ability of the model was quantified by the area under the curve (AUC) of receiver-operating curves (ROC). After validation and calibration of the model, a nomogram was created, and decision curve analysis (DCA) was used to evaluate the clinical net-benefit. UTI was observed in 40 patients (6%). LASSO regression selected the variables elevated serum CRP, positive nitrite, and positive leukocyte esterase for fitting of the model with the highest discriminatory ability. In the testing cohort, model performance evaluation for prediction of UTI showed an AUC of 82 (95% CI 71.5-95.7%). Model calibration plots showed excellent calibration. DCA showed a clinically meaningful net-benefit between a threshold probability of 0 and 80% for the novel model, which was superior to the net-benefit provided by either one of its singular components. In conclusion, we developed and internally validated a logistic regression model and a corresponding highly accurate nomogram for prediction of concomitant positive midstream urine culture in patients presenting with symptomatic ureterolithiasis.
AB - In patients with symptomatic ureterolithiasis, immediate treatment of concomitant urinary tract infection (UTI) may prevent sepsis. However, urine cultures require at least 24 h to confirm or exclude UTI, and therefore, clinical variables may help to identify patients who require immediate empirical broad-spectrum antibiotics and surgical intervention. Therefore, we divided a consecutive cohort of 705 patients diagnosed with symptomatic ureterolithiasis at a single institution between 2011 and 2017 into a training (80%) and a testing cohort (20%). A machine-learning-based variable selection approach was used for the fitting of a multivariable prognostic logistic regression model. The discriminatory ability of the model was quantified by the area under the curve (AUC) of receiver-operating curves (ROC). After validation and calibration of the model, a nomogram was created, and decision curve analysis (DCA) was used to evaluate the clinical net-benefit. UTI was observed in 40 patients (6%). LASSO regression selected the variables elevated serum CRP, positive nitrite, and positive leukocyte esterase for fitting of the model with the highest discriminatory ability. In the testing cohort, model performance evaluation for prediction of UTI showed an AUC of 82 (95% CI 71.5-95.7%). Model calibration plots showed excellent calibration. DCA showed a clinically meaningful net-benefit between a threshold probability of 0 and 80% for the novel model, which was superior to the net-benefit provided by either one of its singular components. In conclusion, we developed and internally validated a logistic regression model and a corresponding highly accurate nomogram for prediction of concomitant positive midstream urine culture in patients presenting with symptomatic ureterolithiasis.
KW - Female
KW - Humans
KW - Logistic Models
KW - Male
KW - Nomograms
KW - Prognosis
KW - Risk Factors
KW - Ureterolithiasis/complications
U2 - 10.1007/s00240-022-01323-4
DO - 10.1007/s00240-022-01323-4
M3 - SCORING: Journal article
C2 - 35441879
VL - 50
SP - 293
EP - 302
JO - UROLITHIASIS
JF - UROLITHIASIS
SN - 2194-7228
IS - 3
ER -