Predictors of outcome in geriatric patients with urinary tract infections

Ginde, Adit A.; Rhee, Sang Ho; Katz, Eric

doi:10.1016/j.jemermed.2004.02.015

Cited by 32 publications

(38 citation statements)

References 27 publications

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“…Such information should be particularly valuable to ED physicians because mortality in elderly people with severe infection is high, 5,8 with rates ranging from 21% to 37% for bacteremia, [24][25][26][27][28][29] ranging from 10% to 53% for pneumonia, 17,[30][31][32] and of 6% for urinary tract infection. 33 The difficulty in identifying a high-risk subpopulation among these patients demonstrates the need to identify such independent risk factors for death in geriatric patients with infection. The unique characteristics of infection in older patients may mask severe illness.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Death in Elderly Emergency Department Patients with Suspected Infection

Caterino

Kulchycki

Fischer

et al. 2009

J American Geriatrics Society

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OBJECTIVES: To identify independent risk factors for death in elderly emergency department (ED) patients admitted for infection and to derive and validate a mortalityprediction rule for such patients. MEASUREMENTS: Primary outcome: 28-day in-hospital mortality. Data were extracted from charts, and multivariate logistic regression were performed to identify independent mortality predictors. A prediction model was constructed and then validated in a second cohort. RESULTS: Nine hundred thirty-five patients were included in the derivation cohort and 2,015 in the validation cohort. Mortality was 6% in the derivation cohort and 7% in the validation cohort. In the derivation cohort, logistic regression revealed five independent mortality predictors: respiratory compromise (respiratory rate 420 breaths per minute or hypoxemia) (odds ratio (OR) 5 4.0, 95% confidence interval (CI) 5 1.7-9.4), tachycardia (heart rate !120 betas per minute; OR 5 3.2, 95% CI 5 1.6-6.3), cardiovascular failure (systolic blood pressure o90 mmHg despite fluid challenge or lactate !4.0; OR 5 9.0, 95% CI 5 4.7-17), preexisting terminal illness (OR 5 5.7, 95% CI 5 2.2-15), and platelet count less than 150,000/mm 3 (OR 5 2.7, 95% CI 5 1.3-5.6). Mortality increased with the number of factors: 0.51% for no factors, 3.1% for one factor, 14% for two factors, 47% for three or more risk factors. The c-statistic was 0.87 for the derivation model and 0.74 for the validation model. Almost 80% of patients in both cohorts were in low-risk groups (0 or 1 factor). CONCLUSION: A rule derived from five readily available variables predicts mortality in infected elderly ED patients and allows identification of a large low-risk subgroup.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Death in Elderly Emergency Department Patients with Suspected Infection

Caterino

Kulchycki

Fischer

et al. 2009

J American Geriatrics Society

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“…Predictors of severe UTI include the presence of fever, altered mental status, hemodynamic instability, leukocytosis, and end-organ dysfunction. 108,109 In-hospital mortality among elders with bacteremic UTI may be as high as 30%. 109 Therefore, hospitalized elders with severe UTI and emerging sepsis should receive broad-spectrum antimicrobial therapy pending urine and blood cultures.…”

Section: Urinary Tract Infectionmentioning

confidence: 99%

Sepsis and Other Infectious Disease Emergencies in the Elderly

Liang

2016

Emergency Medicine Clinics of North America

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“…Dementia in relation to UTIs has been described in the elderly [17,18]. However, according to Ginde et al [19] dementia may not be as important as previous studies have suggested, although this retrospective cohort study had a relatively small sample size.…”

Section: Discussionmentioning

confidence: 67%

“…In addition, laboratory biochemical data were not registered. Taking a small sample size into account, Ginde et al [19] showed that laboratory data were helpful in determining risks in geriatric patients. However, our prediction rule permits GPs to avoid ordering laboratory tests and enhance the possibility of risk calculation immediately.…”

Section: Discussionmentioning

confidence: 99%

A clinical prediction rule for urinary tract infections in patients with type 2 diabetes mellitus in primary care

et al. 2008

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SUMMARYWe aimed to develop a prediction rule for urinary tract infections (UTIs) in patients with type 2 diabetes mellitus (DM2). A 12-month prospective cohort study was conducted in patients with DM2 aged o45 years to predict the occurrence of recurrent UTIs in women and lower UTIs in men. Predictors for recurrent UTI in women (n=81, 2%) and lower UTIs in men (n=93, 3%) were age, number of general practitioner (GP) visits, urinary incontinence, cerebrovascular disease or dementia. In women, renal disease was an additional predictor. The optimum corrected area under the receiver-operating curve (AUC) was 0 . 79 (95 % CI 0 . 74-0 . 83) for women and 0 . 75 (95 % CI 0 . 70-0 . 80) for men. Using a cut-off score of 4, women with a lower risk assignment had a probability of 0 . 3 % for the outcome. For a cut-off score of 6, women with a higher risk assignment had a probability of 5 . 8 %. For men these figures were 0 . 8 and 7 . 1 for a cut-off score of 2 and 4, respectively. Simple variables can be used for the risk stratification of patients.

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Predictors of outcome in geriatric patients with urinary tract infections

Cited by 32 publications

References 27 publications

Risk Factors for Death in Elderly Emergency Department Patients with Suspected Infection

Risk Factors for Death in Elderly Emergency Department Patients with Suspected Infection

Sepsis and Other Infectious Disease Emergencies in the Elderly

A clinical prediction rule for urinary tract infections in patients with type 2 diabetes mellitus in primary care

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