Predictors, trends and outcomes associated with urinary tract infections in intracerebral hemorrhage: insights from a National Inpatient Sample Study (2010-2022).

Abstract

Background: Urinary tract infections (UTIs) are an important concomitant condition among patients with intracerebral hemorrhage (ICH). Data regarding predictors, outcomes and trends relating to UTIs in ICH are lacking.

Methods: A retrospective analysis of data from the Nationwide Inpatient Sample (NIS) for the years January 1, 2010-December 31, 2022 was conducted, employing multivariable logistic regression to examine the associated factors and temporal trends of UTIs in patients with ICH.

Results: Between 1 January 2010 and 31 December 2022, the NIS database contained an unweighted total of 311,581 hospitalizations (weighted estimate, 1,554,702) with ICH coded as either a primary or secondary diagnosis. Among these, 42,271 hospitalizations were combined with UTIs. Our analysis revealed a significant down-trend in the occurrence of UTIs among patients with ICH over the 12-year period, resulting in an overall occurrence rate of 13.6%. The identified associated factors for UTIs included advanced age (≥ 45), female individuals, Black individuals, Hispanic individuals, comorbidities (≥ 1), Charlson comorbidity index (CCI) ≥ 3, medium/large hospital and treatment in South regional hospital. Significant comorbidities that increased the odds of UTIs included deficiency anemia, depression, diabetes (with complications), congestive heart failure, fluid and electrolyte disorders, paralysis, psychoses, peptic ulcer disease excluding bleeding and weight loss. Patients who developed UTIs were associated with worse clinical outcomes, including more frequent conditions (pressure ulcer, pneumonia, transfusion, acute renal failure, deep vein thrombosis, delirium, malnutrition, sepsis), significantly longer hospitalization periods (median 10 vs. 5 days), and substantially increased healthcare expenditures (median $100,923 vs. $62,928). Interestingly, patients with UTIs were associated with lower in-hospital mortality (13.0% vs. 22.9%) (P < 0.001).

Conclusions: There is an association between UTIs and increased healthcare utilization in the setting of ICH. This study revealed several predictors/associated factors of UTIs occurrence with ICH among a nationally representative sample in the United States. These data may assist physicians and healthcare providers in identifying patients at increased risk for UTIs in ICH and, hence, initiate timely interventions.