New insights into risk stratification and individualised management of acute and recurrent cystitis

A newly published multinational analysis by the EAU Section of Infections in Urology proposes an integration of three complementary assessment tools to create a unified clinical framework:

• The Acute Cystitis Symptom Score (ACSS) — validated PROM for symptom severity and QoL
• LUTIRE nomogram — structured recurrence risk profiling
• ORENUC classification — host-related factors and infection complexity

Together, these tools provide a multidimensional profile of patients with AC and RC.

The study explored several multivariate models, each incorporating combinations of clinical, laboratory and host-related variables. Across the analyses, RC was most consistently associated with a greater impact on everyday activities, higher levels of anxiety and depression, chronic constipation, findings of multiple uropathogens and trace proteinuria. In contrast, AC was more strongly linked to pronounced pyuria and an absence of limitations in usual activities. Neither the degree of pyuria nor the bacterial colony count (CFU/µL) correlated with symptom severity.

The findings may reflect a more vigorous innate immune response in patients with AC. In contrast, RC may demonstrate a more attenuated or dysregulated inflammatory pattern. Local innate immune activation in the bladder does not necessarily result in stronger subjective symptoms. However, these interpretation remains hypothetical and requires further studies.

• Structured profiling may improve diagnostic precision and classification.
• Identifying patients with an elevated risk of recurrence means that preventive strategies can be implemented earlier.
• Integrating a combination of the ACSS, LUTIRE and ORENUC in future studies could set a new methodological standard for global real-world data (RWD) efforts in UTI research.

Applying multiple tools might give a clearer clinical classification. Together, they capture symptom burden (ACSS), specific risk indicators for recurrence (LUTIRE) and a general classification of patient- and microbiological risk factors (ORENUC).

An integrated approach based on several classifications may minimise noise and biases in observational cohorts and improve reproducibility. A consistent patient description should form the basis of future multicentre and RWD studies.

A carefully structured assessment of symptoms, host factors and recurrence risk can improve the management of acute and recurrent cystitis. 

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Reference: Identification of Risk Factors in Patients with Recurrent Cystitis May Improve Individualised Management.