This study aimed to translate and validate the Acute Cystitis Symptom Score (ACSS) into the Persian (Farsi) language in accordance with international guidelines. The hypothesis was that the Persian ACSS would demonstrate high reliability and validity in distinguishing women with uncomplicated acute cystitis (uAC) from healthy controls and in monitoring treatment outcomes in Persian-speaking female populations. The study sought to establish the diagnostic accuracy of the Persian ACSS and its utility as a patient-reported outcome measure for clinical practice and research.

This prospective, cross-sectional, observational cohort study involved 100 Persian-speaking women: 50 patients diagnosed with uAC based on clinical symptoms and microbiological confirmation (≥10⁵ CFU/mL of uropathogens) and 50 age-matched control participants without suspected urinary tract infection. The linguistic validation of the ACSS followed international guidelines, including forward and backward translations, reconciliation, and expert review. Participants completed the Persian ACSS. UAC patients completed the questionnaire at baseline (BL) and post-treatment follow-up (FU). Control participants completed it only at BL. Statistical analyses assessed internal consistency (Cronbach's alpha, split-half reliability), diagnostic performance (sensitivity, specificity, accuracy, Youden's index, ROC curve analysis), and compared ACSS domain and item scores between groups (Student's t-test, Welch correction, Mann-Whitney U test, Chi-square test). A predefined cut-off score in the "Typical" domain was used to determine diagnostic accuracy. Changes in symptom severity and quality of life in uAC patients from BL to FU were also evaluated. Statistical significance was set at p < 0.05.

The Persian ACSS demonstrated good internal consistency across its domains. The receiver operating characteristic (ROC) curve analysis of the "Typical" domain summary score revealed high diagnostic accuracy for uAC (Figure 1). Using a cut-off score >6, the Persian ACSS achieved a sensitivity of 97% and a specificity of 96% for diagnosing uAC. Significant differences (p < 0.05) were observed in the "Typical," "Differential," and "Quality of Life" domain scores, as well as most individual item scores, between uAC patients at baseline and control participants. Among the 40 uAC patients who completed the FU assessment, significant improvements (p < 0.05) were noted in symptom severity and quality of life across most ACSS items and domain scores compared to their baseline. However, at follow-up, some "Typical" and "Quality of Life" item scores remained significantly different (p < 0.05) from those of the control group at baseline. The "Dynamics" domain at FU indicated that 75.0% of patients reported feeling "back to normal" or "much better" post-treatment.

The Persian version of the ACSS demonstrated excellent psychometric properties, including high reliability and validity for the diagnosis of uAC in Persian-speaking women. Its high sensitivity and specificity in distinguishing uAC patients from controls highlight its potential as a valuable diagnostic aid. The significant improvements in ACSS scores from baseline to follow-up in uAC patients confirm its utility in monitoring treatment outcomes. However, the persistence of some symptom burden and reduced quality of life compared to healthy controls at follow-up suggests the need for comprehensive management strategies. The findings align with validation studies of the ACSS in other languages, reinforcing its robust nature as a patient-reported outcome measure for uAC.

The Persian ACSS is a valid and reliable tool with high diagnostic accuracy and the ability to effectively monitor treatment outcomes in women with uncomplicated acute cystitis. Its availability in Persian will be invaluable for clinical practice in Farsi-speaking regions, aiding in accurate diagnosis, guiding treatment decisions, and facilitating the assessment of therapeutic efficacy. Furthermore, the Persian ACSS represents a significant contribution to epidemiological and clinical research on uAC in this population, enabling standardized assessment of symptoms and quality of life in future studies.

Foxman B, Brown P. Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs. Infectious disease clinics of North America. 2003;17(2):227-41. Epub 2003/07/10. doi: 10.1016/s0891-5520(03)00005-9. PubMed PMID: 12848468.
Naber KG, Tirán-Saucedo J, Wagenlehner FME. Psychosocial burden of recurrent uncomplicated urinary tract infections. GMS infectious diseases. 2022;10:Doc01. Epub 2022/04/26. doi: 10.3205/id000078. PubMed PMID: 35463815; PubMed Central PMCID: PMCPMC9006425.
Alidjanov JF, Naber KG, Pilatz A, Radzhabov A, Zamuddinov M, Magyar A, et al. Additional assessment of Acute Cystitis Symptom Score questionnaire for patient-reported outcome measure in female patients with acute uncomplicated cystitis: part II. World journal of urology. 2020;38(8):1977-88. Epub 2019/09/25. doi: 10.1007/s00345-019-02948-8. PubMed PMID: 31549179; PubMed Central PMCID: PMCPMC7363736.