Welk Blayne, Liu Kuan, Winick-Ng Jennifer, Shariff Salimah Z
Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Institute for Clinical Evaluative Sciences-Western (ICES Western), London, Ontario, Canada.
Neurourol Urodyn. 2017 Mar;36(3):640-647. doi: 10.1002/nau.22981. Epub 2016 Feb 29.
The objective of this study was to measure the incidence of urinary tract infections (UTIs), urologic reconstruction/urinary diversion, and renal dysfunction after a traumatic spinal cord injury (TSCI).
Retrospective cohort study using administrative data from Ontario, Canada. All incident adult TSCI patients (2002-2013) admitted to a rehabilitation center were included. The impact of lesion level on each outcome was assessed. The rate of outcomes was further compared to an age and sex matched sample from the general population.
A total of 2,023 incident TSCI patients were identified (median follow-up of 4.8 years). Most patients (73%) were male and median age was 50 years. Lesion level included cervical (39%), thoracolumbar (44%), and unknown (17%). The incidence of serious UTIs (requiring emergency room visit or hospital admission) was 40%. Thoracolumbar lesion TSCI patients had significantly greater risk of serious UTIs (HR 1.3, 95%CI 1.1-1.7, P < 0.01) compared to those with a cervical lesion. Urologic reconstruction/urinary diversion was carried out on 2.4% of patients. New onset renal dysfunction was identified in 4.2% (84) TSCI patients. The rate ratios for serious UTIs (10.59, 95%CI 8.71-12.89), urologic reconstruction/urinary diversion (6.48, 95%CI 3.07-13.68), and renal dysfunction (2.55, 95%CI 1.70-3.83) were significantly increased among TSCI patients compared to matched controls.
Urologic disease is still an important source of morbidity for contemporary TSCI patients, and is more common compared to the general population. Neurourol. Urodynam. 36:640-647, 2017. © 2016 Wiley Periodicals, Inc.
本研究的目的是测量创伤性脊髓损伤（TSCI）后尿路感染（UTI）、泌尿系统重建/尿流改道及肾功能不全的发生率。
利用加拿大安大略省的管理数据进行回顾性队列研究。纳入所有入住康复中心的成年TSCI新发病例患者（2002 - 2013年）。评估损伤平面对各结局的影响。将各结局发生率与来自普通人群的年龄和性别匹配样本进行进一步比较。
共确定了2023例TSCI新发病例患者（中位随访时间4.8年）。大多数患者（73%）为男性，中位年龄为50岁。损伤平面包括颈椎（39%）、胸腰椎（44%）和不明（17%）。严重UTI（需要急诊就诊或住院）的发生率为40%。与颈椎损伤患者相比，胸腰椎损伤TSCI患者发生严重UTI的风险显著更高（风险比1.3，95%置信区间1.1 - 1.7，P < 0.01）。2.4%的患者进行了泌尿系统重建/尿流改道。4.2%（84例）TSCI患者出现新发肾功能不全。与匹配对照组相比，TSCI患者中严重UTI（10.59，95%置信区间8.71 - 12.89）、泌尿系统重建/尿流改道（6.48，95%置信区间3.07 - 13.68）和肾功能不全（2.55，95%置信区间1.70 - 3.83）的发生率显著升高。
泌尿系统疾病仍是当代TSCI患者发病的重要来源，且比普通人群更常见。《神经泌尿学与尿动力学》36:640 - 647，2017年。©2016威利期刊公司
