Infect Chemother.  2018 Sep;50(3):228-237. 10.3947/ic.2018.50.3.228.

The Predictive Value of Glycated Hemoglobin and Albumin for the Clinical Course Following Hospitalization of Patients with Febrile Urinary Tract Infection

• Kobayashi
• Uematsu T
• Nakamura G
• Kokubun H
• Mizuno T
• Betsunoh H
• Kamai T

• KMID: 2420907
• DOI: http://doi.org/10.3947/ic.2018.50.3.228

Abstract

BACKGROUND
Diabetes is considered a risk factor for acquisition of febrile urinary tract infection (f-UTI), but information on the association of diabetes with subsequent course of the disease is lacking. Thus, we investigated the clinical variables including diabetic status which determined the clinical course in patients with community-acquired f-UTI.
MATERIALS AND METHODS
Patients hospitalized consecutively for f-UTI between February 2016 and January 2018 were used for this single center study. The routine laboratory tests including blood glucose and glycated hemoglobin (HbA1c) were done and empiric treatment with parenteral antibiotics was commenced on admission. The clinical course such as duration of fever (DOF) and length of hospital stay (LOS) were compared among groups classified by the clinical variables.
RESULTS
Among the101 patients admitted for f-UTI, 15 patients with diabetes (14.9%) experienced significantly longer febrile period and hospitalization compared to those with hyperglycemia (n = 18, 17.8%) or those without diabetes and hyperglycemia (n = 68, 67.3%). Of the laboratory parameters tested on admission and several clinical factors, the presence of diabetes and risk factors for severe complicated infection (hydronephrosis, urosepsis, and disseminated intravascular coagulopathy) as well as HbA1c and albumin were identified as predictors for LOS by univariate analysis, whereas none of the variables failed to predict DOF. In the subsequent multivariate analysis, HbA1c levels and albumin levels were isolated as independent predictors of LOS.
CONCLUSION
Patients with higher HbA1c and lower albumin levels required the longest period of hospitalization. Thus, an evaluation of diabetic and nutritional status on admission will be feasible to foretell the clinical course and better manage the subset of patients at risk of prolonged hospitalization.

Keyword

Albumin; Glycated hemoglobin; Febrile; Urinary tract infection

MeSH Terms

Anti-Bacterial Agents
Blood Glucose
Fever
Hemoglobin A, Glycosylated*
Hospitalization*
Humans
Hyperglycemia
Length of Stay
Multivariate Analysis
Nutritional Status
Risk Factors
Urinary Tract Infections*
Urinary Tract*
Anti-Bacterial Agents
Blood Glucose

Figure

• 

  Figure 1 Probability of hospital stay indicated by Kaplan-Meier curves according to HbA1c (A) or albumin (B) levels. Patients with higher HbA1c or lower albumin required longer hospitalization. Note that the lower curves represent better outcomes of shorter hospital stay as discharge from the hospital is counted as an event.

• 

  Figure 2 Probability of hospital stay indicated by Kaplan-Meier curves according to the combination of HbA1c and albumin levels.group A: patients with lower HbA1c and higher albumin, group B: patients with higher HbA1c and lower albumin, group C: patients with both higher or lower albumin.Patients in group A experienced the shortest hospital stay.

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