Clinical characteristics and nomogram model for predicting the risk of recurrence of complicated urinary tract infection in pediatric patients

Complicated urinary tract infection (cUTI) has higher incidences of antibiotic resistance, recurrence, chronicity, and progression. However, there has been no prediction model for cUTI recurrence in pediatric patients for targeted interventions. This study aimed to establish a nomogram to p`redict the risk of cUTI recurrence for better prevention and treatment of cUTI in pediatric patients. The nomogram was developed based on a retrospective cohort that included 421 pediatric patients with cUTI at West China Second University Hospital from January 2020 to August 2023. The patients were randomly divided into a training set and a validation set in a 3:1 ratio. Logistic regression analysis was used to identify risk factors and construct the nomogram for predicting the risk of cUTI recurrence, followed by validation and performance analysis. Of the 421 children with cUTI, the recurrence rate of cUTI was 68.4% (288 cases) during an average follow-up duration of 22.9 months. The nomogram comprised female gender, history of urinary tract surgery, Escherichia coli in urine culture, renal dysfunction, and vesicoureteral reflux as predictors of cUTI recurrence in pediatric patients. The model showed favorable performance with a C-index of 0.735 in the training dataset and a C-index of 0.750 in the validation dataset. The clinical decision curves revealed that the nomogram was clinically useful. The first reliable nomogram was constructed for predicting the risk of cUTI recurrence in pediatric patients, which would be beneficial for clinicians to identify children with high risks of cUTI recurrence for targeted interventions.