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Войти в исследования World journal of urology · 2025
Gross hematuria in nonagenarians admitted to a urological ward: prevalence, predictors, and outcomes.
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Banner Andreas, Schneider Magdalena, Madersbacher Stephan, Grabovac Igor
Аннотация
PURPOSE: To describe the trajectories of nonagenarians admitted to a urological ward and to identify risk factors for admission due to gross hematuria (GH) and its impact on discharge status.
METHODS: A retrospective cohort study of nonagenarians admitted to a tertiary care center between 2014 and 2022 was conducted. Data on demographics, comorbidities, medication, and outcomes were collected. Frailty was assessed via the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS). Multivariable Poisson regression was used to assess risk factors for GH-related admissions. Secondary endpoints included changes in discharge status and survival, analyzed using Kaplan-Meier and restricted mean survival time (RMST).
RESULTS: Among 317 patients (median age 92 yrs [IQR 91-94], 63.7% male), 134 (42.3%) were admitted for hematuria. Antithrombotic therapy (aRR = 1.40, 95% CI 1.02-1.92, p = 0.013) and history of bladder cancer (aRR = 1.46, 95% CI 1.08-1.96, p = 0.013) were significantly associated with hematuria-related admissions. Increased social service utilization was more frequent among hematuria patients (13.4% vs. 8.7%), reaching significance in sensitivity analysis (aRR = 2.17 95%CI 1.16-4.06, p = 0.02). One-year mortality was higher among hematuria patients (34.3% vs. 24.5%), with lower RMST (12 vs. 15 months). In-hospital mortality during the index admission was low across both groups. The CSHA-CFS had limited discriminative power to predict 1-year mortality (AUC = 0.59).
CONCLUSION: GH is a common reason for admission in nonagenarians and may indicate broader vulnerability. Geriatric assessment tools could aid in clinical decision-making and discharge planning. Future research should validate frailty-based risk stratification and address functional decline related to hospitalization in this population.
METHODS: A retrospective cohort study of nonagenarians admitted to a tertiary care center between 2014 and 2022 was conducted. Data on demographics, comorbidities, medication, and outcomes were collected. Frailty was assessed via the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS). Multivariable Poisson regression was used to assess risk factors for GH-related admissions. Secondary endpoints included changes in discharge status and survival, analyzed using Kaplan-Meier and restricted mean survival time (RMST).
RESULTS: Among 317 patients (median age 92 yrs [IQR 91-94], 63.7% male), 134 (42.3%) were admitted for hematuria. Antithrombotic therapy (aRR = 1.40, 95% CI 1.02-1.92, p = 0.013) and history of bladder cancer (aRR = 1.46, 95% CI 1.08-1.96, p = 0.013) were significantly associated with hematuria-related admissions. Increased social service utilization was more frequent among hematuria patients (13.4% vs. 8.7%), reaching significance in sensitivity analysis (aRR = 2.17 95%CI 1.16-4.06, p = 0.02). One-year mortality was higher among hematuria patients (34.3% vs. 24.5%), with lower RMST (12 vs. 15 months). In-hospital mortality during the index admission was low across both groups. The CSHA-CFS had limited discriminative power to predict 1-year mortality (AUC = 0.59).
CONCLUSION: GH is a common reason for admission in nonagenarians and may indicate broader vulnerability. Geriatric assessment tools could aid in clinical decision-making and discharge planning. Future research should validate frailty-based risk stratification and address functional decline related to hospitalization in this population.