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).
CONCLUSION: 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.
Varda BK, McNabb-Baltar J, Sood A, Ghani KR, Kibel AS, Letendre J, Menon M, Sammon JD, Schmid M, Sun M, Trinh QD, Bhojani N. Are you the author?
Division of Urologic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University of Michigan, Ann Arbor, MI; Division of Urology, Université de Montréal, Montreal, Canada; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
Reference: Urology. 2015 Feb 7. pii: S0090-4295(14)01380-6.