Urinary tract infections are not only a factor that restricts the quality of life of many urological patients but they also significantly increase the risk of stroke, according to a recent study from the USA. In today's blog post, I would like to briefly present this study, which in my opinion makes a special contribution to interdisciplinarity in urology.
Acute infections have long been regarded as so-called stroke triggers. However, it was still unknown whether all infections in the body increase the risk equally, or whether there are differences depending on the organ system.
The new study by Solly Sebastian and colleagues, therefore, investigated the influence of infections on the risk of acute ischaemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage at different times.
Methodologically, the present study is a database analysis, whereby patient data were included in the evaluation between 2006 and 2013. The researchers used the quota ratio (= risk ratio, odds ration; OR) to determine the relationships between a type of infection and the risk of stroke.
The results showed that, in principle, any type of infection increased the risk of acute ischemic stroke. However, the researchers found the greatest correlation between urinary tract infections and strokes (OR = 5.32 [95%-KI: 3.69-7.68]), whereby the risk was greatly increased especially within a 7-day window.
Between urinary tract infections and intracerebral bleeding, however, there was a significantly lower risk within a 14-day window (OR = 1.80 [95% CI: 1.04-3.11]) and a 120-day period (OR = 1.54 [1.23-1.94]) compared to patients without infections.
The present study clearly showed a more than 3-fold increased risk of stroke within 30 days in patients with urinary tract infections. The study design, in which each patient served as his or her own control, further strengthens the results. Therefore: Especially if there are other risk factors for strokes in your patients, you should closely monitor the patients during the urological therapy period.
As a possible explanation for the connection between infections and strokes, the authors stated that infections usually lead to an increase in the number of leukocytes, which favors thrombogenesis. In addition, thrombus formation, infections, and the associated inflammations promote the activation of blood platelets.
Urinary tract infections are therefore not just a urological problem. Rather, their health consequences also spread to related medical fields, such as cardiology or hematology. Although the study does not specify whether the urinary tract infections were uncomplicated or complicated, the mere finding that such urinary tract infections increase the risk of stroke is a good reason to treat patients in an interdisciplinary manner. This should be especially true when additional comorbidities complicate the situation.
Original work:
Sebastian S et al., Infection as a stroke trigger: Associations between different organ system infection admissions and stroke subtypes. Stroke 2019; doi:10.1161/STROKEAHA.119.025872