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Ragonese M, Fettucciari D, Carbone L, Gavi F, Montesi M, Scarciglia E, Russo P, Sanesi DM, Marino F, Foschi N, Pinto F, Franceschi F, Racioppi M, Sacco E, Covino M. Predictive Factors for Major Complications and Urological Cancer Diagnosis in Older Adults (≥80 Years) Admitted to the Emergency Department for Hematuria. J Clin Med 2024; 13:2874. [PMID: 38792416 PMCID: PMC11122226 DOI: 10.3390/jcm13102874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Gross Hematuria is a relevant cause of admission to the emergency department in the general population and particularly in older adults (≥80 years). This specific urological symptom is often underestimated and usually associated with benign conditions such as urinary infections or poor hydration. Nevertheless, hematuria could lead to severe acute complications or be the first symptom of urological cancers. Methods: We retrospectively analyzed clinical data from 1169 patients aged ≥80 years consecutively admitted to the emergency department for hematuria. The primary endpoint of the study was to identify risk factors for major complications, and the secondary endpoint was to analyze risk factors for urological cancer diagnosis. The median age was 85 years (IQR 82-88 years), and 908 (77%) were males. Among them, 449 (38.4%) had a past medical history of urological neoplasm (kidney, ureter, bladder, prostate, or urethral cancer). Results: Overall, 87 patients (7.4%) had major complications (patient death, septic shock, and admission to the intensive care unit). Worse vital signs at admission, fever, and confusion (p < 0.001, OR 18.0 IC 95% [5.5-58.7]; p = 0.015, OR 2.0 IC 95% [1.1-3.5]; p = <0.001, OR 4.2 IC 95% [1.9-3.5], respectively), as well as lower hemoglobin values and higher Charlson comorbidity index (p < 0.001, OR 0.8 IC 95% [0.7-0.9]), p = 0.002, OR = 1.2 [1.1-1.3]) were independent predictive factors for major complications. The multivariate analysis identified as risk factors for diagnosis of urological cancer older age, male sex and higher comorbidity (OR 1.05 IC95% [1-1.09]; OR 2.19 IC95% [1.42-3.39] and OR 1.11 IC95% [1.2-1.2], respectively); interestingly the presence of indwelling vesical catheter (IVC) (OR 0.44 IC95% [0.24-0.82]) resulted as an independent factor for absence of urological cancers. Conclusions: Hematuria is a frequent symptom in older adults admitted to the emergency department. While this is often associated with benign conditions, there are some risk factors for major complications and for urological cancer that must be taken into account to identify the patients who need further evaluation or prompt hospital admission.
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Affiliation(s)
- Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
| | - Daniele Fettucciari
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Luigi Carbone
- Department of Emergency Medicine, Ospedale Fatebenefratelli Isola Tiberina, Gemelli Isola, 00186 Rome, Italy
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Marco Montesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Eros Scarciglia
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Domenico Maria Sanesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
| | - Francesco Pinto
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
| | - Francesco Franceschi
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy (F.M.)
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
| | - Emilio Sacco
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
- Department of Urology, Ospedale Fatebenefratelli Isola Tiberina, Gemelli Isola, 00186 Rome, Italy
| | - Marcello Covino
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00136 Rome, Italy (E.S.); (M.C.)
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy
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Froom P, Shimoni Z, Dusseldorp N, Benbassat J. Asymptomatic Microscopic Hematuria in Inpatient Nonsurgical Adults. Am J Clin Pathol 2023; 159:221-224. [PMID: 36694371 DOI: 10.1093/ajcp/aqac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/16/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This study sought to determine the proportion of nonsurgical inpatients with asymptomatic microscopic hematuria (AMH) who qualified for urologic investigation according to consensus guidelines. METHODS The study population included all patients acutely admitted to the internal medicine departments of Israeli regional hospitals between 2014 and 2017. RESULTS Of 29,086 consecutive admissions, 10,116 (34.8%) underwent dipstick urinalysis and 8,389 (28.8%) underwent reflex microscopic urinalysis. After the exclusion of patients with a urethral catheter or a positive urine culture, 2,206 had 3 or more RBCs per high-power field, and as many as 2,052 (7.1% of the entire cohort and 24.4% of all patients undergoing microscopic urinalysis) met the criteria for a urologic workup. CONCLUSIONS We conclude that according to the consensus guidelines, an unreasonably high proportion of hospitalized nonsurgical patients would be referred for a urologic workup of uncertain clinical utility because of an incidental AMH finding.
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Affiliation(s)
- Paul Froom
- Clinical Utility Department, Laniado Hospital, Netanya, Israel.,School of Public Health, University of Tel Aviv, Tel Aviv, Israel
| | - Zvi Shimoni
- Office of the Chief Medical Officer, Laniado Hospital, Netanya, Israel
| | - Nathan Dusseldorp
- Office of the Chief Information Officer, Sanz Medical Center, Laniado Hospital, Netanya, Israel
| | - Jochanan Benbassat
- Department of Medicine (retired), Hadassah University Hospital, Jerusalem, Israel
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Drapkina OM, Samorodskaya IV, Larina VN. [The asymptomatic microhematuria in the physician's practice]. TERAPEVT ARKH 2021; 93:71-78. [PMID: 33720629 DOI: 10.26442/00403660.2021.01.200596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022]
Abstract
The review article presents data on: a) definition of microhematuria and diagnosis; b) prevalence estimation and causes of the asymptomatic microscopic hematuria; c) diagnostic approaches for the first time identified of microhematuria; d) follow-up monitoring of patients with asymptomatic hematuria; e) feasibility of medical screening for microhematuria. The analysis includes recommendations of Russian and foreign urological associations, the results of cohort and observational studies, previous study reviews. The identification of 3 or more red blood cells during microscopic examination should be considered microhematuria. There is no uniform examination algorithm for all patients. The basic principle is an individual diagnostic tactic, taking into account the anamnesis, age, concomitant diseases and risk factors. The purpose of a comprehensive examination is to exclude life-threatening conditions (malignant neoplasms and/or glomerular kidney damage). In some cases, after research, the cause of microhematuria remains unclear and monitoring is required. Routine screening of the population in order to detect microhematuria is currently not justified.
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Affiliation(s)
- O M Drapkina
- National Research Center for Therapy and Preventive Medicine
| | | | - V N Larina
- Pirogov Russian National Research Medical University
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Lucca I, Hofbauer SL, Haitel A, Susani M, Shariat SF, Klatte T, De Martino M. Urinary expression of genes involved in DNA methylation and histone modification for diagnosis of bladder cancer in patients with asymptomatic microscopic haematuria. Oncol Lett 2019; 18:57-62. [PMID: 31289472 DOI: 10.3892/ol.2019.10330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/25/2019] [Indexed: 12/18/2022] Open
Abstract
The aim of the present study was to identify and test a urine marker panel of genes involved in DNA methylation and histone modification for the detection of urothelial carcinoma of the bladder (UCB). RNA samples obtained from the voided urine of 227 patients with asymptomatic microscopic haematuria (AMH) were analysed. Gene array analysis was performed on 18 randomly selected cDNA samples, which revealed that histone deacetylase 9 (HDAC9), HDAC3, tRNA (cytosine-5-)-methyltransferase1 and DNA methyltransferase 1 were differentially expressed between patients with UCB and control subjects. Subsequently, reverse transcription-quantitative polymerase chain reaction analysis was employed to test the performance of the identified four-gene panel on the remaining 209 cDNA samples. In this targeted discovery cohort, all four genes were significantly associated with UCB on univariable analyses [each odds ratio (OR) >2, P<0.05], but only HDAC3 was significant following multivariable analysis (OR=2.8, P=0.011). The addition of HDAC3 to a base risk factor model improved its accuracy by 1.4%. These data suggest that urinary HDAC3 is associated with the presence of UCB in patients with AMH; however, HDAC3 improved the accuracy of the established risk factors only to a marginal extent.
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Affiliation(s)
- Ilaria Lucca
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.,Department of Urology, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | | | - Andrea Haitel
- Department of Pathology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Martin Susani
- Department of Pathology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria.,Karl Landsteiner Society, Urology and Andrology, A-1090 Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, NY 10011, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Michela De Martino
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria
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