Abstract
Background and objectives: To investigate the risk factors for emphysematous cystitis (EC) compared to those of acute cystitis (AC) to increase clinicians awareness of the possibility for the aggravation of patient status. Materials and methods: We retrospectively reviewed a total of 54 patients who were hospitalized with a diagnosis of EC by abdominal computed tomography (CT) scan from 2006 to 2020. The control group included 92 patients who were hospitalized for the treatment of AC in the same period. We sought to identify the clinical features and predisposing diseases, such as age, sex, diabetes mellitus (DM), hypertension (HTN), cerebrovascular accident (CVA), chronic kidney disease (CKD), neurogenic bladder (NB), history of urinary tract infection (UTI), and emphysematous pyelonephritis (EPN), that were associated with the development of EC. Results: The median (interquartile range (IQR)) age of the patients with EC was older than that of the patients with AC (78.5 (15.3) years (range: 52–100) vs. 70.0 (26.5) years (range: 28–97 years)). Sepsis and mortality occurred only in the EC group (48.1% and 11.1%, respectively). The univariate analysis of predisposing factors revealed that age, DM, HTN, CVA, CKD, and NB were significantly associated with EC. In the multivariate analysis, DM (OR, 6.251; 95% CI, 2.254–17.250; p < 0.001), CKD (OR, 18.439; 95% CI, 3.421–99.404; p = 0.001), NB (OR, 7.374; 95% CI, 1.993–27.285; p = 0.003) were associated with EC. Conclusions: The results of this study revealed that DM, CKD, and NB were significant risk factors for EC. The tendency toward sepsis and high mortality underscore the need for careful observation while treating patients with EC with the risk noted above.
Highlights
Emphysematous urinary tract infection (UTI), including emphysematous pyelonephritis (EPN) and emphysematous cystitis (EC), is characterized by gas-forming infections in related organs
A total of 54 EC patients were identified, and all 92 patients with acute cystitis (AC) were set as the control group
No patients with EPN were detected in the AC group, whereas 10.2% of EC patients were diagnosed with EPN
Summary
Emphysematous urinary tract infection (UTI), including emphysematous pyelonephritis (EPN) and emphysematous cystitis (EC), is characterized by gas-forming infections in related organs. Among gas-forming infections, EPN develops to severe necrosis of the kidney and perirenal tissues with a high mortality rate of 21%. EC shows infection of the bladder wall and lumen with presentations varying from nonspecific clinical symptoms of cystitis to systemic response, including fever and myalgia up to urosepsis (mortality rate, 7%) [2,3,4]. The risk factors for EC are older women, diabetes mellitus, neurogenic bladder, urinary tract outlet obstruction, recurrent UTI, and urethral catheter placement [8,9,10]. We sought to identify the clinical features and predisposing diseases, such as age, sex, diabetes mellitus (DM), hypertension (HTN), cerebrovascular accident (CVA), chronic kidney disease (CKD), neurogenic bladder (NB), history of urinary tract infection (UTI), and emphysematous pyelonephritis (EPN), that were associated with the development of EC. The tendency toward sepsis and high mortality underscore the need for careful observation while treating patients with EC with the risk noted above
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