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.

Keywords: Mortality in Emergency Department Sepsis (MEDS) score; National Early Warning Score (NEWS); emphysematous cystitis (EC); receiver operating characteristic curve (ROC); scoring systems.

Figure 1

The AUC of ROC for MEDS indicated 0.819 at 12 of the cut-off point to predict the mortality risks of patients with EC. AUC = area under the curve; ROC = receiver operating characteristic curve.

Figure 2

The AUC of ROC for REMS indicated 0.685 at 10 of the cut-off point to predict the mortality risks of patients with EC. AUC = area under the curve; ROC = receiver operating characteristic curve.

Figure 3

The cumulative survival rates of patients with EC were calculated to predict the 30-day mortality rate by Kaplan–Meier. The cut-off point of REMS was 10.

Figure 4

The MEDS was more than 12, and the mortality case numbers were 5, with a mortality rate of 14.3%. The REMS was more than 10, and the mortality case numbers were 3, with a mortality rate of 8.6%.