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P OSTER
A BSTRACTS
IgE antibodies in serum. Additional work is needed to test large numbers
of samples for clinical application.
B136
Does this Patient have Benign Prostatic Hypertrophy with Bladder
Outlet Obstruction?
K. A. D’Silva , 1 P. Dahm, 2 C. L. Wong. 1 1. Geriatric Medicine,
University of Toronto, Toronto, ON, Canada; 2. Urology, University of
Florida, Gainesville, FL.
Background: Although benign prostatic hyperplasia (BPH) is
very common in older men, not all men with histologic BPH will develop
the non-specific symptoms known as lower urinary tract symptoms
(LUTS). Likewise, not all men with LUTS have histologic BPH.
Bladder outlet obstruction (BOO) refers to the pressure gradient at
the bladder neck/prostatic urethra which can be measured by invasive
urodynamics. Accurate diagnosis of BOO is important because it
can cause not only immediate symptoms including severe pain and
urinary retention but also lead to complications, e.g.incontinence and
renal insufficiency.
Objective: To systematically review the evidence on the diagnostic
accuracy of office-based tests for BPH with BOO in males
with LUTS.
Methods: Search of MEDLINE and EMBASE (from 1950 to
August 12, 2010), Cochrane Central Register of Controlled Trials via
Ovid, and references of retrieved articles, to identify diagnostic studies
of patients with LUTS due to BPH with BOO.
Data selection: Prospective studies comparing at least one diagnostic
test, feasible in a clinical setting and readily available to a nonspecialist
clinician, to the gold standard reference test, invasive urodynamic
studies. Studies were excluded if they used pediatric patients
or if participants had confounding medical conditions.
There were 6692 unique citations identified with 9 prospectively
conducted studies (N=1217 patients) meeting inclusion criteria and
describing use of 2 symptom questionnaires as well as individual
symptom(s). All tests were administered and scored based on international
guidelines. The best constellation of symptoms that suggested
BPH with BOO was ‘poor stream and frequency and/or nocturia’
(positive LR, 1.76; 95% CI, 1.17- 2.64). The most useful
symptom in which the absence made a diagnosis of BPH with BOO
less likely, was nocturia (negative LR, 0.19, 95% CI, CI 0.05-0.79). The
best symptom questionnaire to support or rule out a diagnosis of
BPH with BOO was the International Prostatic Symptom Score (I-
PSS) at a cut-off of 8 (summary positive LR, 1.34; 95% CI, 1.06-1.70;
summary negative LR, 0.28, 95% CI, CI 0.12-0.70).
Conclusions: Although urodynamic investigations are the gold
standard for diagnosis of BPH with BOO, symptoms obtained
through history may be useful for diagnosis. The best evidence supports
asking the patient about nocuturia, stream and frequency.
B137
Predicting Mortality Following Clostridium difficile Infection.
L. Archbald-Pannone, 1,2 R. Pinkerton, 1,3 R. Guerrant. 1,3 1. Internal
Medicine, University of Virginia, Charlottesville, VA; 2. Division of
General Medicine, Geriatrics, and Palliative Care, University of
Virginia, Charlottesville, VA; 3. Division of Infectious Diseases and
International Health, University of Virginia, Charlottesville, VA.
Supported By: NIH/ NIAID 5K23AI074681-04
Background: With increasing incidence & severity of Clostridium
difficile (C. difficile) infection (CDI), there are no objective factors
at diagnosis that have been proven to predict poor outcome. We
evaluated demographics, co-morbidities, medications, & laboratory
tests in a cohort of hospitalized patients to determine factors that
could predict death following CDI diagnosis. Methods: After obtaining
consent, adult inpatients with CDI diagnosed in our hospital
(September 2008-May 2010, UVA HSR-IRB 13630) were followed 12
months after C. difficile diagnosis to determine short-term mortality
(STM, 1 month) & long-term (LTM, 12 months). Age & Charlson comorbidities
score were calculated on day of CDI diagnosis. White
blood cell count (WBC) & renal function (BUN, GFR, & Creatinine)
were recorded on day of diagnosis; serum albumin recorded within 7
days of diagnosis (mean, if multiple); & medications prior to diagnosis
were recorded. Binary logistic regression (SPSS 19) determined a
model to best predict mortality, using univariate predictors of mortality
(student’s t-tests, chi-squared) & backward regression to eliminate
non-significant factors. Significance set p ≤ 0.05. Results: 85 subjects;
age 63.4 years (sd 16.9); Charlson score 5.8 (sd 4.0); time to death 2.4
months (sd 3.6); STM rate 32.9% (n=28); LTM rate 52.9% (n=45).
Factors associated with STM & LTM, respectively: age (both
p