Chen Yi-Hsuan, Hsieh Ming-Shun, Hu Sung-Yuan, Huang Shih-Che, Tsai Che-An, Tsai Yi-Chun
Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan.
J Pers Med. 2023 Feb 13;13(2):318. doi: 10.3390/jpm13020318.
Emphysematous cystitis (EC) is a complicated urinary tract infection (UTI) characterized by gas formation within the bladder wall and lumen. Immunocompetent people are less likely to suffer from complicated UTIs, but EC usually occurs in women with poorly controlled diabetes mellitus (DM). Other risk factors of EC include recurrent UTI, neurogenic bladder disorder, blood supply disorders, and prolonged catheterization, but DM is still the most important of all aspects. Our study investigated clinical scores in predicting clinical outcomes of patients with EC. Our analysis is unique in predicting EC clinical outcomes by using scoring system performance.
We retrospectively collected EC patient data from the electronic clinical database of Taichung Veterans General Hospital between January 2007 and December 2020. Urinary cultures and computerized tomography confirmed EC. In addition, we investigated the demographics, clinical characteristics, and laboratory data for analysis. Finally, we used a variety of clinical scoring systems as a predictor of clinical outcomes.
A total of 35 patients had confirmed EC, including 11 males (31.4%) and 24 females (68.6%), with a mean age of 69.1 ± 11.4 years. Their hospital stay averaged 19.9 ± 15.5 days. The in-hospital mortality rate was 22.9%. The Mortality in Emergency Department Sepsis (MEDS) score was 5.4 ± 4.7 for survivors and 11.8 ± 5.3 for non-survivors ( = 0.005). For mortality risk prediction, the AUC of ROC was 0.819 for MEDS and 0.685 for Rapid Emergency Medicine Score (REMS). The hazard ratio of univariate and multivariate logistic regression analyses of REMS for EC patients was1.457 ( = 0.011) and 1.374 ( = 0.025), respectively.
Physicians must pay attention to high-risk patients according to clinical clues and arrange imaging studies as soon as possible to confirm the diagnosis of EC. MEDS and REMS are helpful for clinical staff in predicting the clinical outcome of EC patients. If EC patients feature higher scores of MEDS (≥12) and REMS (≥10), they will have higher mortality.
气肿性膀胱炎（EC）是一种复杂的尿路感染（UTI），其特征是膀胱壁和腔内形成气体。免疫功能正常的人患复杂尿路感染的可能性较小，但EC通常发生在糖尿病（DM）控制不佳的女性中。EC的其他危险因素包括复发性UTI、神经源性膀胱疾病、血液供应障碍和长期导尿，但DM仍然是所有方面中最重要的。我们的研究调查了临床评分对预测EC患者临床结局的作用。我们的分析在通过使用评分系统性能预测EC临床结局方面具有独特性。
我们回顾性收集了2007年1月至2020年12月期间台中荣民总医院电子临床数据库中的EC患者数据。尿培养和计算机断层扫描确诊为EC。此外，我们调查了人口统计学、临床特征和实验室数据以进行分析。最后，我们使用各种临床评分系统作为临床结局的预测指标。
共有35例患者确诊为EC，其中男性11例（31.4%），女性24例（68.6%），平均年龄69.1±11.4岁。他们的住院时间平均为19.9±15.5天。院内死亡率为22.9%。存活者的急诊脓毒症死亡率（MEDS）评分为5.4±4.7，非存活者为11.8±5.3（P = 0.005）。对于死亡风险预测，MEDS的ROC曲线下面积（AUC）为0.819，快速急诊医学评分（REMS）为0.685。REMS对EC患者单因素和多因素逻辑回归分析的风险比分别为1.457（P = 0.011）和1.374（P = 0.025）。
医生必须根据临床线索关注高危患者，并尽快安排影像学检查以确诊EC。MEDS和REMS有助于临床工作人员预测EC患者的临床结局。如果EC患者的MEDS评分（≥12）和REMS评分（≥10）较高，他们的死亡率将会更高。
