title: Urolithiasis and urinary tract infection among patients with inflammatory bowel disease: a review of US emergency department visits between 2006 and 2009.
abstract: OBJECTIVE
  To compare patients with inflammatory bowel disease (IBD) to a general population of urinary stone formers who present to US emergency departments with infected urolithiasis. Patients with IBD are at risk for both infection and stone formation, however studies investigating emergent urolithiasis presentations for this population are limited.
  
  
  METHODS
  Using the Nationwide Emergency Department Sample (2006-2009) we identified all patients presenting to the US emergency departments with a diagnosis of upper tract urolithiasis. We then described a subgroup with the concomitant diagnosis of IBD. We compared rates of urinary tract infection (UTI), sepsis, organ failure, admission, and mortality between the 2 groups. Using multivariate analysis, we determined whether or not IBD was a predictor of UTI, sepsis, and hospitalization.
  
  
  RESULTS
  Overall, 14,352 patients had concomitant IBD and urolithiasis. IBD patients with urolithiasis presented with infections (10.4% vs 9.1%; P <.001), sepsis (0.6% vs 0.2%; P <.001), and end-organ failure (6.3% vs 1.6%; P <.001) more frequently than non-IBD patients. They were also more likely to have characteristics independently associated with infection and sepsis, such as older age and female gender. In adjusted analyses, IBD was an independent predictor of infection (odds ratio [OR] = 1.3 [1.14-1.46]; P <.0001), sepsis (OR = 1.8 [1.09-2.92]; P <.0001), and admission (OR = 3.3 [3.04-3.64]; P <.0001).
  
  
  CONCLUSIONS
  IBD patients with urinary calculi have greater odds of UTI, renal failure, and sepsis compared to the general stone-forming population. The increased occurrence and severity of infected urolithiasis in this select group of patients warrants screening for stone disease, improved outpatient medical management, and early elective surgery for detected stones.
authors: Division of Urologic Surgery, the Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: bvarda@partners.org.
authors: Briony K
authors: BK
authors: Varda
authors: Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Julia
authors: J
authors: McNabb-Baltar
authors: Division of Urologic Surgery, the Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors: Akshay
authors: A
authors: Sood
authors: Department of Urology, University of Michigan, Ann Arbor, MI.
authors: Khurshid R
authors: KR
authors: Ghani
authors: Division of Urologic Surgery, the Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Adam S
authors: AS
authors: Kibel
authors: Division of Urology, Université de Montréal, Montreal, Canada.
authors: Julien
authors: J
authors: Letendre
authors: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors: Mani
authors: M
authors: Menon
authors: Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
authors: Jesse D
authors: JD
authors: Sammon
authors: Division of Urologic Surgery, the Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Marianne
authors: M
authors: Schmid
authors: Division of Urology, Université de Montréal, Montreal, Canada.
authors: Maxine
authors: M
authors: Sun
authors: Division of Urologic Surgery, the Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Division of Urology, Université de Montréal, Montreal, Canada.
authors: Naeem
authors: N
authors: Bhojani
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000401:mortality; D052878:Urolithiasis / Q000453:epidemiology* / Q000401:mortality; D055815:Young Adult