Factors associated with an unfavorable clinical course in hospitalized patients with pelvic inflammatory disease: a retrospective cohort study of 117 patients from a Japanese academic institution

Abstract

Background This study aimed to determine the factors associated with an unfavorable clinical course (emergency surgery and/or prolonged hospitalization) in patients requiring hospitalization owing to pelvic inflammatory disease (PID). Methods A retrospective study was performed on 117 patients diagnosed with PID who were admitted to our hospital between January 2014 and December 2018. Multivariate regression analysis was conducted to determine the factors associated with emergency surgical intervention, and prolonged hospitalization in a subgroup of successful expectant management (n = 93). Results The average age (mean ± standard deviation) of the patients was 41.2 ± 12.5 years; 16 (13.7%) were postmenopausal; 81 patients (69.2%) complicated with a tubo-ovarian abscess (TOA) of which 59 (72.9%) had an ovarian endometrioma; and 19 patients (16.2%) had a history of various intrauterine manipulations. Emergency surgery was performed in 24 patients (20.5%), and patients with TOA underwent emergency surgery more often than did patients without TOA (25.9% vs. 8.3%, p = 0.03), and TOA was associated with longer length of hospital stay (17.1 days vs. 8.0 days, p = 0.01). Smoking, postmenopausal status, past medical history of PID, and high C-reactive protein (CRP) level at admission were significantly associated with emergency surgery. In patients with successful expectant management, obesity (body mass index ≥ 30) and high WBC and CRP level at admission were significantly associated with prolonged hospitalization. Conclusions Of the patients requiring hospitalization owing to PID, TOA was associated with both emergency surgery and prolonged hospital stay. Patients with increased inflammatory markers and obesity should be considered to be at a high risk for unfavorable clinical course in the management of PID.

Causal Relationship Between Endometriosis and Pelvic Inflammatory Diseases: Mendelian Randomization Study

“…Firstly, the infiltration of macrophages and abnormal activation of vascularization in endometriosis lead to adhesions and structural changes in pelvic organs. [20][21][22] Subsequently, these altered structures make it easier for bacteria to thrive, thus increasing the risk of PID. Secondly, the presence of stagnant blood in endometriotic lesions may raise the pH of surrounding organs, impacting the local microbial environment, lead to bacterial infection, and subsequently induce PID.…”

Association between cardiovascular health and pelvic inflammatory disease: Analyses of the NHANES 2015 to 2018

“…[21] A retrospective study from Japan found that obesity prolongs hospitalization for PID. [6] Obesity has been shown to impair immunological response by generating pro-inflammatory substances in adipose tissue and affecting T-cell activity. [22] Similarly, investigations have linked overweight status, as well as obesity classes I, II, and III, to heightened risks of endometritis subsequent to vaginal, non-instrumental deliveries.…”

“…[4,5] In addition, recurrent episodes of PID can burden society and the healthcare system. [6] Thus, investigating the risk factors linked to PID is crucial for offering early interventions.…”

Association between dietary trace minerals and pelvic inflammatory disease: data from the 2015–2018 National Health and Nutrition Examination Surveys

“…Before reaching a copper intake of 0.85 mg/day (close to the RDA), the link between copper intake and PID in the overweight subgroup (≥30.0 kg/m 2 ) was flat and decreased rapidly when the RDA of copper was reached. A retrospective study has shown that obese PID patients were identified to be associated with an unfavorable clinical course ( 9 ). Thus, adequate copper intake may become even more important for older and overweight women with PID.…”

“…In the United States, approximately 0.5 to 1 million cases of PID develop annually, and the average cost is up to $3,025 per episode for PID therapy ( 7 , 8 ). At the same time, the majority of PID patients are prone to experience disease recurrence, resulting in additional burdens on society and healthcare systems ( 9 ). Hence, it is crucial to examine the risk factors associated with PID to enable early intervention.…”