Scoring Systems to Evaluate the Mortality Risk of Patients with Emphysematous Cystitis: A Retrospective Observational Study

Abstract

Background: 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. Materials and Methods: 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. Results: 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 (p = 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 (p = 0.011) and 1.374 (p = 0.025), respectively. Conclusion: 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.

A Case Study of Emphysematous Cystitis in a Non-diabetic Patient Following Empagliflozin Use: An Uncommon Presentation

“…For non-diabetic individuals, the development of EC is hypothesized to be multifactorial. Factors like compromised immunity, diminished tissue perfusion, elevated tissue glucose concentrations, and the presence of alternative metabolic substrates like albumin and lactulose might converge to create conditions conducive for anaerobic metabolism and fermentation in the urinary bladder [ 8 ]. As medical research continues, a deeper understanding of EC's pathophysiology will pave the way for better diagnostic and therapeutic approaches.…”

“…Prompt investigation and treatment are vital to prevent severe complications, including sepsis, emphysematous pyelonephritis, bladder rupture, and death. Initial and commonly successful interventions include the administration of intravenous broad-spectrum antibiotics, insertion of a Foley catheter for bladder drainage, and strict glycemic control [ 7 , 8 ]. If a large number of blood clots are present in the bladder, drainage becomes especially important to prevent tamponade of the bladder [ 6 ].…”

Better Performance of Modified Scoring Systems to Predict the Clinical Outcomes of Vibrio Bacteremia in the Emergency Department: An Observational Study

“…The original MEDS and qSOFA were designed for simplicity and ease of calculation, often excluding blood test data [49][50][51]. However, this simplicity came at the cost of some accuracy.…”