title: Predictors of outcome in geriatric patients with urinary tract infections.
abstract: A study was conducted to determine the prognosis of geriatric patients with urinary tract infections (UTIs) and identify clinical factors associated with adverse outcomes. This retrospective, cohort study identified elderly patients (age > or =65 years) presenting to an academic, urban Emergency Department (ED) during a 16-week period with UTI, suggested by urinalysis and pertinent symptoms. There were 37 demographic and clinical variables analyzed as potential predictors of outcome. Morbidity was defined as in-hospital death, Intensive Care Unit (ICU) admission, hospital length of stay (LOS) >2 days, or hospital intravenous (i.v.) antibiotics >2 days. Factors identified by univariate analysis were combined using multiple logistic regression to identify independent predictors of morbidity. There were 284 patients who met selection criteria. Thirteen patients (4.6%) died during hospitalization and 27 (9.5%) had ICU admission, 139 (48.9%) had LOS >2 days, and 75 (26.4%) had i.v. antibiotics >2 days. Multivariate analysis identified the following variables as independent predictors of adverse outcomes: mental status change, frequent UTIs, other nonurinary infections, abnormal temperature, tachycardia, hypotension, elevated BUN, hyperglycemia, elevated WBC, and relative neutrophilia. Regression models for adverse outcomes had sensitivities from 74.8% to 96.2% and specificities from 31.1% to 69.0%. In conclusion, this study defines high rates of morbidity for geriatric patients with UTIs and describes predictive variables that may help identify low-risk patients. These data may lay the foundation for determining specific guidelines for disposition of this high-risk patient population.
authors.affiliation: Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
authors.forename: Sang Ho
authors.initials: SH
authors.lastname: Rhee
authors.forename: Eric D
authors.initials: ED
authors.lastname: Katz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008923:Missouri / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014505:Urban Population; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000401:mortality