Quantifying the Cardiovascular and Immunologic Changes after Spinal Cord Injury to Aid Diagnosis of Clinically Meaningful Infections

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7. Project Summary/Abstract Urinary tract infection (UTI, including catheter-associated UTI), is consistently amongst the top three reasons for health care use for persons with spinal cord injury (SCI), with a yearly cost of over $2 billion, not to mention the significant impact of the condition on quality of life. While the importance of recognizing and treating true UTI is evident, distinguishing this condition from asymptomatic bacteriuria (ASB, a positive urine culture without clinical signs or symptoms of infection) is particularly challenging after SCI due to the impaired ability to sense the most common signs and symptoms used in UTI diagnosis. This often leads to subjective interpretations of UTI signs and symptoms by patients and SCI providers alike. Bladder instrumentation with either indwelling or intermittent catheterization is often necessary after SCI to safely eliminate urine and maintain continence, however leads to high rates of ASB that do not need to be treated. Inappropriate treatment of ASB with antibiotics leads to the development of multi-drug resistant organisms, which are higher in persons with SCI than their age and co-morbidity-matched cohorts, conveying high morbidity and mortality. A possible solution to this conundrum is a diagnostic support tool for UTI after SCI; previously successful tools measure the degree of abnormality of multiple physiologic variables to measure the severity of acute disease. To calculate the degree of abnormality, however, we must have a better sense of the normal values for vital sign measurements and common laboratory studies for the SCI patient population. Therefore, the aims of this study are to 1) Establish the association between chronic SCI and baseline vital sign and lab measurements through a case-control study utilizing national Veterans Health Administration (VHA) data sources; and 2) Determine the positive predictive value of a constellation of physiologic variables defined as a screening tool for severe UTI after SCI through a retrospective cohort study. The data obtained from this study will support a NIH R01 proposal aimed to externally validate and assess the performance of the severe UTI screening tool prospectively. The assembled study team and environment are uniquely suited to completing this work, and have the support of clinical, research, administrative and patient advocacy leadership locally and nationally. This project supports the NICHD/NCMRR priority of identifying and treating secondary conditions associated with disability.