Impact of Urinary Tract Infections on In-Hospital Outcomes in Acute Myocardial Infarction: Insights from the National Inpatient Sample (2016-2021)

Impact of Urinary Tract Infections on In-Hospital Outcomes in Acute Myocardial Infarction: Insights from the National Inpatient Sample (2016-2021) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Urinary Tract Infections on In-Hospital Outcomes in Acute Myocardial Infarction: Insights from the National Inpatient Sample (2016-2021) Abdul Rehman, Israel Gitangaza, Guangzhi Cong, Shaobin Jia, Xueping Ma, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6535029/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Patients with acute myocardial infarction (AMI) who develop urinary tract infections (UTIs) are at a significantly higher risk of experiencing severe complications, but the impact of UTIs on in-hospital outcomes remains unclear. We aim to study the impact of UTIs on the in-hospital outcomes among patients with AMI. Methods: Data were extracted from the National Inpatient Sample database from 2016 to 2021 using ICD-10 codes to identify hospital admissions with a principal diagnosis of AMI with and without UTIs. The primary outcome was in-hospital mortality, while secondary outcomes included the incidence of cardiogenic shock, acute renal failure, gastrointestinal bleeding, stroke, and length of stay. Multivariate regression analyses were conducted to adjust for potential confounders. Results: Among 760,177 AMI patients, 33,631 (4.4%) had a concurrent UTIs. The presence of UTIs was significantly associated with adverse in-hospital outcomes, including a 10% increase in in-hospital mortality (aOR 1.10, 95% CI 1.00–1.10, P < 0.001), a 60% higher risk of cardiogenic shock (aOR 1.60, 95% CI 1.50–1.60, P < 0.001), and more than double the risk of acute renal failure (aOR 2.40, 95% CI 2.40–2.50, P < 0.001). Additionally, UTIs were associated with increased gastrointestinal bleeding (aOR 1.80, 95% CI 1.70–1.90, P < 0.001) and stroke (aOR 2.30, 95% CI 2.10–2.50, P < 0.001). Patients with UTIs also experienced a significantly longer in-hospital stay (aOR 3.20, 95% CI 3.10–3.30, P < 0.001). Conclusions : AMI patients with UTIs are associated with significantly worse in-hospital outcomes, including increased mortality and higher rates of complications. Acute myocardial infarction Urinary tract infections National Inpatient Sample In-Hospital Outcomes Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Acute myocardial infarction (AMI) is a primary global health concern and a leading cause of mortality, impacting nearly 3 million individuals annually and accounting for over 1 million deaths each year in the United States.[ 1 , 2 ]. Despite advancements in AMI treatment and management, outcomes remain poor for patients with multiple comorbidities[ 3 ]. Urinary tract infections (UTIs) are among the most common infections acquired in hospitals, particularly prevalent among the elderly and immunocompromised populations, affecting approximately 3–10% of hospitalized AMI patients[ 4 , 5 ]. Over 150 million UTIs occur globally each year, with high incidence rates among hospitalized patients[ 6 ]. Growing evidence suggests that UTIs can exacerbate cardiovascular conditions, particularly in AMI patients[ 7 ]. Infections, particularly UTIs, activate systemic inflammatory pathways through mechanisms such as bacteremia and endotoxemia, triggering immune responses that can lead to endothelial dysfunction, plaque instability, and thrombus formation, ultimately worsening atherosclerosis and AMI outcomes [ 8 , 9 ].These infection-induced inflammatory and thrombotic responses have been associated with complications such as arrhythmias, heart failure, and reinfarction in AMI patients, highlighting the potential severity of UTIs in AMI patients [ 10 ].Studies have demonstrated that UTIs related endotoxemia can elevate troponin levels and contribute to myocardial injury, further linking UTIs to poor cardiovascular outcomes[ 11 ]. Despite affecting 3–10% of hospitalized AMI patients and being particularly common among hospitalized individuals, the specific impact of UTIs on in-hospital outcomes remains underexplored, with most research focusing on other infections[ 12 , 13 ]. In the present study, utilizing the National Inpatient Sample, we aimed to evaluate in-hospital outcomes in patients with AMI and concurrent UTIs. We assessed how UTIs may impact in-hospital mortality and complications during AMI hospitalizations, offering valuable insights into the impact of UTIs on AMI management and patient care. 2. Materials and methods 2.1 Data Source Using data from the National Inpatient Sample (NIS), a publicly available all-payer inpatient healthcare database administered by the Agency for Healthcare Research and Quality, this study examined national estimates of hospital admissions in the United States between 2016 and 2021. The NIS contains a 20% stratified sample of all discharges from US hospitals, except rehabilitation and long-term acute care facilities, and represents hospitals from over 1000 [14]. Diagnoses and procedures were identified using ICD-10-CM codes. Since the NIS is a de-identified dataset, the study was exempt from institutional review board approval. The dataset used in this study, NIS, is publicly available and can be accessed from www.hcup-us.ahrq.gov . 2.2 Study Population Patients with AMI were identified among hospitalized patients with either ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI), using ICD-10-CM codes. Individuals with missing data or aged under 18 years were excluded. The identified AMI patients were categorized into two groups: those with UTIs and those without (Figure 1) . 2.3 Study variables and outcomes We detailed the patient's clinical and socioeconomic characteristics, encompassing demographics, insurance coverage, household income at the median level, determined by the patient's ZIP code, and hospital attributes such as geographical setting (rural or urban) and hospital bed capacity (categorized as small, medium, and large), and teaching hospital status. Comorbidities were assessed using the Elixhauser Comorbidity Index[15]. Other clinically relevant comorbidities included smoking, dyslipidemia, previous myocardial infarction (MI), prior Percutaneous Coronary Intervention (PCI), prior Coronary Artery Bypass Grafting (CABG), diabetes, hypertension, obesity, and chronic renal failure (CRF). The types of AMI were classified as STEMI and NSTEMI. A full list of the ICD-10-CM codes used to identify these conditions is provided in Table S1 . 2.4 Outcomes The primary outcome assessed was in-hospital mortality. Secondary outcomes included hospitalization complications and length of stay (LOS). Hospital complications consisted of cardiogenic shock (CS), acute kidney injury (AKI), gastrointestinal (GI) bleeding, and stroke. All outcomes were identified using ICD-10-CM codes, as detailed in Table S1 . 2.5 Statistical Analysis The National Inpatient Sample (NIS) was utilized to produce weighted national estimates for tracking and analyzing healthcare outcomes. This study applied these weighted data to represent the full U.S. inpatient population, following guidelines set by the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality[16]. Patients’ demographic and clinical characteristics were summarized using categorical data presented as percentages. In contrast, continuous data was shown as mean ± standard deviation (SD) or interquartile range (IQR) based on their distribution. Continuous baseline variables were analyzed using a weighted linear regression model, and categorical variables were evaluated with a weighted chi-square test. Multivariate Analyses were adjusted for potential confounders to assess the independent relationship between UTIs and in-hospital outcomes, including mortality, complications, CS, AKI, GI bleeding, stroke, and LOS. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated to determine the strength and precision of these associations. Additionally, subgroup analyses were conducted to compare mortality rates among AMI patients with UTIs, stratified by gender, age (<65 and ≥65 years), race, STEMI and NSTEMI, hypertension, diabetes mellitus (DM), Chronic Renal Failure (CRF), percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). All statistical analyses were performed using EmpowerStats version 4.20 http:// www.empowerstats.com . Statistical significance for all tests was set at a two-tailed P value of less than 0.05. The figures were created using Adobe Illustrator https://adobe.com/products/illustrator and BioRender https://BioRender.com. 3. Results From 2016 to 2021, among 760,177 AMI patients, 33,631 (4.4%) had a concurrent UTI. Of these, 7,206 (21.4%) were STEMI patients, and 26,425 (78.6%) were NSTEMI patients ( Fig. 1 ). 3.1 Baseline Characteristics of the Study Population Table 1 presents the baseline characteristics and comorbidities of AMI patients with and without concurrent UTIs. In the unmatched cohort, patients with UTIs were significantly older (74.8 ± 12.1 years vs. 66.6 ± 13.3 years, P < 0.001) and predominantly female (66.9% vs. 35.9%, P < 0.001). Patients with UTIs also exhibited a higher prevalence of CRF (33.0% vs. 20.3%, P < 0.001) but were less likely to be smokers (33.5% vs. 49.7%, P < 0.001) or have dyslipidemia (57.0% vs. 64.2%, P < 0.001). Additionally, patients with UTIs had a lower prevalence of prior AMI (13.6% vs. 16.0%, P < 0.001) and prior PCI (13.3% vs. 16.7%, P < 0.001). They were more frequently diagnosed with NSTEMI (78.6% vs. 69.9%, P < 0.001), admitted to urban non-teaching hospitals (22.2% vs. 20.4%, P < 0.001), and relied more often on Medicare as their primary payer (78.1% vs. 56.0%, P < 0.001). 3.2 In-Hospital Outcomes The presence of UTIs was significantly associated with adverse in-hospital outcomes, including a 10% increase in in-hospital mortality (aOR 1.10, 95% CI 1.00–1.10, P < 0.001), a 60% higher risk of CS (aOR 1.60, 95% CI 1.50–1.60, P < 0.001), and more than double the risk of ARF (aOR 2.40, 95% CI 2.40–2.50, P < 0.001). Additionally, UTIs was associated with increased GI bleeding (aOR 1.80, 95% CI 1.70–1.90, P < 0.001) and stroke (aOR 2.30, 95% CI 2.10–2.50, P < 0.001). Patients with UTIs also experienced a significantly longer in-hospital stay (aOR 3.20, 95% CI 3.10–3.30, P < 0.001) (Table 2) ( Fig. 2 ). 3.3 Subgroup Analysis The mortality risk for AMI patients with concurrent UTIs compared to those without UTIs across prespecified subgroups is presented in Table 3 . Subgroups include stratification by gender, age (< 65 and ≥ 65 years), race, STEMI, NSTEMI, hypertension, diabetes mellitus, CRF, prior PCI, and prior CABG. Although the association between UTIs and mortality risk remained significant across all subgroups, the highest mortality risk was observed among patients aged ≤ 65, with a 2.60-fold increased risk (aOR: 2.60; 95% CI: 2.40–2.90; p < 0.001) ( Fig. 4 ). 4. Discussion In this national inpatient sample study of 760,177 patients with AMI, hospitalized in the United States from 2016 to 2021, we report the following findings. First, we observed that UTIs in patients with AMI are linked with a higher risk of adverse in-hospital outcomes, including mortality, CS, AKI, GI Bleeding, Stroke, and LOS. Second, we conducted subgroup analyses that the mortality impact was most pronounced in younger patients (≤ 65 years), highlighting the potential severity of UTIs in this population. Third, these associations persisted across all examined subgroups, including STEMI/NSTEMI and patients with various comorbidities. This study advances the current literature by shifting the focus from UTIs as antecedent risk factors to their role as in-hospital complications following AMI. Unlike prior research, which has predominantly examined infections and UTIs as potential triggers of cardiovascular events, we specifically investigate UTIs acquired after AMI onset during the same hospitalization. This distinction is methodologically and clinically significant, highlighting infections not merely as precipitating factors but as complications that may exacerbate hospital outcomes. By analyzing a large, nationally representative inpatient dataset, our study addresses a critical knowledge gap, providing insights into the prognostic implications of UTIs developing during hospitalization for AMI, an understudied area in contemporary cardiovascular in-hospital outcomes research. In contrast, previous studies have explored UTIs and other infections as transient risk factors for AMI or stroke in community-based populations. For instance, Reeve et al. and Pedersen et al. utilized self-controlled case series designs to demonstrate a short-term increase in AMI or stroke risk following UTIs.[ 17 , 18 ] Similarly, Sims et al. reported temporal associations between infections and subsequent ischemic events, likely mediated by systemic inflammatory pathways.[ 11 ] While most of the previous studies established infections as potential instigators of cardiovascular events, they did not evaluate UTIs as complications arising during AMI hospitalization, a key contribution of our work. UTIs have been recognized as an important comorbidity in a hospitalized population, with significantly increased risk of systemic inflammation and multiorgan dysfunction [ 19 ]. Several studies have reported that UTIs prevalence rates ranged from 3–10% across the patient populations studied, with notable differences depending on demographic or clinical characteristics[ 20 , 21 ]. Within the present study, the prevalence of UTIs among the AMI patients was 4% in accordance with existing research findings [ 11 , 22 ]. These results underscore the need for careful monitoring and timely management of UTIs in patients hospitalized with AMI. The significant association between UTIs and elevated in-hospital mortality is consistent with previous studies that have suggested systemic inflammation worsens cardiovascular outcomes [ 23 , 24 ]. UTIs triggers inflammatory and thrombotic pathways, leading to endothelial dysfunction, plaque instability, and myocardial injury ( Fig. 3 ). These mechanisms likely explain the observed 10% increase in in-hospital mortality among AMI patients with UTIs [ 25 ]. In subgroup analysis, the highest mortality risk associated with UTIs was seen in patients ≤ 65 years of age. This finding is contrary to the common belief that older populations are at higher risk and may reflect the lower baseline mortality risk in younger patients, implying that relative impact of UTIs is more pronounced in younger patients [ 25 ]. Younger patients may also present with more atypical symptoms, resulting in delayed diagnosis and treatment of AMI and UTIs and, therefore, worse outcomes [ 26 , 27 ]. The association between UTI and complications, such as CS, AKI, GI bleeding, and stroke, provides clear evidence of how systemic infection impacts AMI patients. The 60% increased risk of CS in UTIs patients reflects hemodynamic instability resulting from infection and systemic inflammation [ 28 , 29 ] ( Fig. 3 ). AKI's more than twofold risk may be due to a combination of renal hypoperfusion, the nephrotoxic effect of antibiotics, and contrast agents administered for diagnostic and therapeutic purposes [ 30 , 31 ]. The increased risk of GI bleeding in patients with UTIs may be due to drugs such as anticoagulants, systemic inflammatory reactions, and a high likelihood of stress-related mucosal lesions in markedly ill people [ 32 , 33 ]. In addition, the increased risk of stroke likely arises from infection-dependent prothrombotic states, endothelial dysfunction, and potential arrhythmia, which can occur due to systemic inflammation[ 34 , 35 ] ( Fig. 3 ). These findings emphasize the importance of increased awareness and attention to the management of these complications in patients with AMI and concurrent UTIs. Ultimately, patients with concurrent UTIs experienced longer hospital stays, likely related to the increased burden of complications, and required more intensive monitoring and treatment. Longer hospitalizations have not only put a burden on the healthcare system, but may also have increased the risk of additional hospital-acquired complications and continue to put patients into a cycle of poor outcomes [ 36 , 37 ] The findings of this study have important clinical implications. First, the presence of UTIs in AMI patients should be a timely and aggressive management strategies to overcome the risk of adverse outcomes. This includes timely initiating of appropriate antibiotics, monitoring for signs of sepsis, and minimizing nephrotoxic exposures. Second, patients at higher risk, such as younger individuals and those with comorbidities like diabetes or CRF, may benefit from closer monitoring and personalized treatment approaches. Finally, the observed complications underscore the need for a collaborative approach to managing AMI patients with concurrent UTIs, including cardiologists, infectious disease specialists, and intensivists. Study Limitations and Strengths Our study has several strengths. To our knowledge, it is the first to investigate the impact of UTIs on in-hospital outcomes in a large, nationally representative cohort of AMI patients in the United States. We specifically examine the impact of UTIs acquired during hospitalization for AMI, highlighting them as in-hospital complications rather than pre-admission triggers of cardiovascular events, offering new insights not addressed in previous research. Using the NIS, a comprehensive all-payer database ensures that our findings are generalizable across diverse populations and healthcare settings. Moreover, the large sample size reduces the chances of type II errors and allows for comprehensive subgroup analyses to assess potential effect modifiers. However, this study is not without limitations. First, as with any study utilizing administrative data, depending on ICD-10 codes may introduce diagnostic errors or coding biases. Due to the lack of microbiological data in the NIS, we could not assess UTIs' severity, causative organisms, or antibiotic resistance profiles. Furthermore, information on specific treatment protocols was unavailable, such as the type and timing of antibiotics or catheter management. Lastly, our findings demonstrate associations rather than causal relationships as an observational study. Despite these limitations, the study addresses a critical knowledge gap by explaining the impact of UTIs on in-hospital outcomes in AMI patients. It highlights the need for enhanced clinical vigilance and preventative strategies. This provides a strong foundation for the potential therapeutic application of LBP in metabolic health management for elderly populations. 5. Conclusion Our study highlights that UTIs are associated with significantly worse in-hospital outcomes in AMI patients, including higher mortality, increased complications, and prolonged hospital stays. These findings emphasize the need for prompt recognition and management of UTIs in this population to improve outcomes. The observed heightened mortality risk in younger patients warrants further investigation to understand the underlying mechanisms and guide targeted interventions. Future research should explore the long-term impact of UTIs on AMI outcomes and evaluate strategies to mitigate the adverse effects of infections in this high-risk group. Abbreviations AMI Acute Myocardial Infarction UTIs Urinary Tract Infections STEMI ST-Segment Elevation Myocardial Infarction NSTEMI Non-ST-Segment Elevation Myocardial Infarction PCI Percutaneous Coronary Intervention CABG Coronary Artery Bypass Grafting OR Odds Ratio aOR Adjusted Odds Ratio CI Confidence Interval GI Gastrointestinal LOS Length of Stay HCUP Healthcare Cost and Utilization Project SD Standard Deviation CS Cardiogenic Shock AKI Acute Kidney Injury CKD chronic kidney disease AHRQ Agency for Healthcare Research and Quality ICD-10-CM/PCS International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System Declarations Ethics Approval and Consent to Participate The NIS database (www.hcup-us.ahrq.gov) is publicly available and contains no identifiable information; the local institutional review board waived the requirement for informed consent under the Health Insurance Portability and Accountability Act. Consent for Publication Not applicable. Availability of data and material The data that support the findings of this study are openly available in the National (Nationwide) Inpatient Sample (NIS) at ( https://hcup-us.ahrq.gov/nisoverview.jsp ). Competing Interests The authors declare no competing interests. Clinical trial number Not applicable. Funding This work was supported by the Natural Science Foundation of Ningxia Province (Project No. 2023AAC02071, 2022AAC03479), Open competition mechanism to select the best candidates for key research projects of Ningxia Medical University (Project No. XIKF230205), the Central government guided local science and technology project (Project No. 2022FRD05046) and the National Natural Science Foundation of China (82260086, 82060057). Author Contributions Guangzhi Cong contributed to the study design, supervision, critically revised the manuscript, and approved the final version for publication. Abdul Rehman contributed formal analysis and drafted the original manuscript. Xueping Ma, Ru Yan, and Shaobin Jia: Funding acquisition, Resources, and Supervision. Israel Gitangaza, Bo Shi, Rui Yan, Shizhe Fu, Kairu Wang, Baotong He, Aoqin Gu, and Yixuan Xu contributed to the critical revision of the manuscript for important intellectual content. All authors contributed to the article and approved the submitted version. ACKNOWLEDGMENTS We acknowledge HCUP data collection partners for making this study possible (https://www.hcup-us.ahrq.gov). References Mechanic, O.J., M. Gavin, and S.A. Grossman, Acute Myocardial Infarction , in StatPearls . 2025, StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.: Treasure Island (FL) ineligible companies. Disclosure: Michael Gavin declares no relevant financial relationships with ineligible companies. Disclosure: Shamai Grossman declares no relevant financial relationships with ineligible companies. Reed, G.W., J.E. Rossi, and C.P. 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Medina-Leyte, D.J., et al., Endothelial Dysfunction, Inflammation and Coronary Artery Disease: Potential Biomarkers and Promising Therapeutical Approaches. Int J Mol Sci, 2021. 22 (8). Hwang, S.Y., et al., Comparison of factors associated with atypical symptoms in younger and older patients with acute coronary syndromes. J Korean Med Sci, 2009. 24 (5): p. 789-94. Khan, I.A., et al., Atypical Presentations of Myocardial Infarction: A Systematic Review of Case Reports. Cureus, 2023. 15 (2): p. e35492. Smeeth, L., et al., Risk of Myocardial Infarction and Stroke after Acute Infection or Vaccination. New England Journal of Medicine, 2004. 351 (25): p. 2611-2618. Poisson, S.N., S.C. Johnston, and S.A. Josephson, Urinary Tract Infections Complicating Stroke. Stroke, 2010. 41 (4): p. e180-e184. Goyal, A., et al., Acute Kidney Injury , in StatPearls . 2025, StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.: Treasure Island (FL) ineligible companies. Disclosure: Parnaz Daneshpajouhnejad declares no relevant financial relationships with ineligible companies. Disclosure: Muhammad Hashmi declares no relevant financial relationships with ineligible companies. Disclosure: Khalid Bashir declares no relevant financial relationships with ineligible companies. Morales-Alvarez, M.C., Nephrotoxicity of Antimicrobials and Antibiotics. Advances in Chronic Kidney Disease, 2020. 27 (1): p. 31-37. Al Aseri, Z., et al., Evidence-based Management of Major Bleeding in Patients Receiving Direct Oral Anticoagulants: An Updated Narrative Review on the Role of Specific Reversal Agents. J Cardiovasc Pharmacol Ther, 2023. 28 : p. 10742484231202655. Cook, D.J., et al., Risk Factors for Gastrointestinal Bleeding in Critically Ill Patients. New England Journal of Medicine, 1994. 330 (6): p. 377-381. Paganini-Hill, A., et al., Infection and Risk of Ischemic Stroke. Stroke, 2003. 34 (2): p. 452-457. Oh, S.E. and N.S. Parikh, Recent Advances in the Impact of Infection and Inflammation on Stroke Risk and Outcomes. Curr Neurol Neurosci Rep, 2022. 22 (3): p. 161-170. Lagoe, R.J., P.E. Johnson, and M.P. Murphy, Inpatient hospital complications and lengths of stay: a short report. BMC Res Notes, 2011. 4 : p. 135. Cai, Y., et al., The impact of healthcare associated infections on mortality and length of stay in Singapore—A time-varying analysis. Infection Control & Hospital Epidemiology, 2020. 41 (11): p. 1315-1320. Tables Tables 1 to 3 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Table1.docx Table2.docx Table3.docx SupplementaryTableS1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Israel","middleName":"","lastName":"Gitangaza","suffix":""},{"id":463158957,"identity":"6c41a791-c3ce-4d03-828b-e5f4b2a0d440","order_by":2,"name":"Guangzhi Cong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIie2RvQrCMBCAA4W6HLqeIO0rBAKl4Mu0CJ2is4OIIOii4uhjdHKOiHWJe3bBwUkoiIOIxkGcYtwE8w3HDfdxf4Q4HD8J6IBBrTIUOmnYKYLErD4pEq2ArdJNc8Xpq6mRcLxblacrMipleVS9GEhlvclNCpWdFgrAoL6dLpu8eAwGWaaMCgJFgciqcrdk3H8oCJFRCRfALoJiOlD8wPjNQiEKIhQJpnPFvX17ZKFQyaNYCtRHjrz2DMH/tEs4lkx1r339yn3JzzpZF+bB3vDxGW3LNd7pm2qHw+H4H+4NG0l3PW+TkAAAAABJRU5ErkJggg==","orcid":"","institution":"Institute of Cardiovascular Medicine, General Hospital of Ningxia Medical 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University","correspondingAuthor":false,"prefix":"","firstName":"Ru","middleName":"","lastName":"Yan","suffix":""},{"id":463158961,"identity":"ba744ef8-69b4-45fe-b0ea-91f31623ba45","order_by":6,"name":"Bo Shi","email":"","orcid":"","institution":"School of Clinical Medicine, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Shi","suffix":""},{"id":463158962,"identity":"d26dad35-bd4c-4fdc-8314-19616210d45b","order_by":7,"name":"Congyan Ye","email":"","orcid":"","institution":"School of Clinical Medicine, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Congyan","middleName":"","lastName":"Ye","suffix":""},{"id":463158963,"identity":"e42de0e3-1e8c-472a-b7f4-afe07843acc0","order_by":8,"name":"Shizhe Fu","email":"","orcid":"","institution":"School of Clinical Medicine, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shizhe","middleName":"","lastName":"Fu","suffix":""},{"id":463158964,"identity":"5118317d-dd04-469d-9c4f-43478855ee5c","order_by":9,"name":"Rui Yan","email":"","orcid":"","institution":"School of Clinical Medicine, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Rui","middleName":"","lastName":"Yan","suffix":""},{"id":463158965,"identity":"f5a12406-f2ed-4372-8abd-69f095806612","order_by":10,"name":"Baotong He","email":"","orcid":"","institution":"School of Clinical Medicine, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Baotong","middleName":"","lastName":"He","suffix":""},{"id":463158966,"identity":"0f82e761-43c7-45c8-8c60-adb6bbd4dce3","order_by":11,"name":"Aoqin Gu","email":"","orcid":"","institution":"School of Clinical Medicine, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Aoqin","middleName":"","lastName":"Gu","suffix":""},{"id":463158967,"identity":"dda5d22b-9fe9-46e9-a9d8-b5aae3a65044","order_by":12,"name":"Yixuan Xu","email":"","orcid":"","institution":"School of Clinical Medicine, Ningxia Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yixuan","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2025-04-26 12:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6535029/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6535029/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83676482,"identity":"a3db8e1d-b600-4d40-8bfa-235f256bda2e","added_by":"auto","created_at":"2025-05-30 14:56:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13902,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy flow diagram.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e NIS, National Inpatient Sample; AMI, Acute Myocardial Infarction; UTI, Urinary Tract Infections; STEMI, ST-Elevation Myocardial Infarction; NSTEMI, Non-ST-Elevation Myocardial Infarction.\u003c/p\u003e","description":"","filename":"Binder11.png","url":"https://assets-eu.researchsquare.com/files/rs-6535029/v1/17481900af3721cdff9ed106.png"},{"id":83676483,"identity":"f9641472-f479-4356-af78-ca34d659a7ad","added_by":"auto","created_at":"2025-05-30 14:56:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":86689,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssociation of UTIs with clinical outcomes in AMI Patients.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValues are presented as odds ratios (OR) with 95% confidence intervals (CI).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations: \u003c/strong\u003eAMI = Acute Myocardial Infarction; UTIs = Urinary Tract Infections; GI = Gastrointestinal.\u003c/p\u003e\n\u003cp\u003eAdjusted for Age, Female, Race, Teaching Status, Number of Beds, Hospital Division, Income Quartile, Smoking, Prior Myocardial Infarction, Prior Percutaneous Coronary Intervention, Prior Coronary Artery Bypass Grafting, Diabetes Mellitus, Hypertension, Obesity, and Chronic Renal Failure.\u003c/p\u003e","description":"","filename":"Binder12.png","url":"https://assets-eu.researchsquare.com/files/rs-6535029/v1/906a8128d4b0a2bad47c5742.png"},{"id":83676484,"identity":"ed189b0d-fa8e-42c9-9246-cae948d84e49","added_by":"auto","created_at":"2025-05-30 14:56:32","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":96898,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe Impact of Urinary Tract Infections on Inflammatory Pathways and Clinical Outcomes in Acute Myocardial Infarction.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Binder13.png","url":"https://assets-eu.researchsquare.com/files/rs-6535029/v1/c023e72a257f2153f8099de2.png"},{"id":83676492,"identity":"d92fdf3d-cd28-4936-8d83-9e536c2ccc2d","added_by":"auto","created_at":"2025-05-30 14:56:32","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":320602,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCENTRAL ILLUSTRATION: The figure displays the important findings of this study.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Binder14.png","url":"https://assets-eu.researchsquare.com/files/rs-6535029/v1/76a1f6c5bdfc859af89678b2.png"},{"id":101952553,"identity":"25159c96-e4df-4230-ab66-37088d4c780d","added_by":"auto","created_at":"2026-02-05 10:57:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1500464,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6535029/v1/dadaf30b-c054-450d-a267-70b84770f614.pdf"},{"id":83677257,"identity":"702816f5-934d-4cd4-8b33-b700694003dc","added_by":"auto","created_at":"2025-05-30 15:04:32","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25645,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6535029/v1/ec893f1620d4267695b19613.docx"},{"id":83677258,"identity":"862c5a99-e16b-4216-80fc-582576993acf","added_by":"auto","created_at":"2025-05-30 15:04:32","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":19565,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6535029/v1/241739e10b68f5064dc49e02.docx"},{"id":83676490,"identity":"8c7f7a40-6ddc-4ed2-ad3d-5fc7bf6cf350","added_by":"auto","created_at":"2025-05-30 14:56:32","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":23831,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-6535029/v1/9e2c2c8423b0c28c2a937bde.docx"},{"id":83676488,"identity":"b86a4c76-7eff-4580-8118-ec8b91e794d0","added_by":"auto","created_at":"2025-05-30 14:56:32","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":16659,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6535029/v1/3581f79d7b948d191fb3ffeb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Urinary Tract Infections on In-Hospital Outcomes in Acute Myocardial Infarction: Insights from the National Inpatient Sample (2016-2021)","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAcute myocardial infarction (AMI) is a primary global health concern and a leading cause of mortality, impacting nearly 3\u0026nbsp;million individuals annually and accounting for over 1\u0026nbsp;million deaths each year in the United States.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Despite advancements in AMI treatment and management, outcomes remain poor for patients with multiple comorbidities[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Urinary tract infections (UTIs) are among the most common infections acquired in hospitals, particularly prevalent among the elderly and immunocompromised populations, affecting approximately 3\u0026ndash;10% of hospitalized AMI patients[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Over 150\u0026nbsp;million UTIs occur globally each year, with high incidence rates among hospitalized patients[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGrowing evidence suggests that UTIs can exacerbate cardiovascular conditions, particularly in AMI patients[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Infections, particularly UTIs, activate systemic inflammatory pathways through mechanisms such as bacteremia and endotoxemia, triggering immune responses that can lead to endothelial dysfunction, plaque instability, and thrombus formation, ultimately worsening atherosclerosis and AMI outcomes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].These infection-induced inflammatory and thrombotic responses have been associated with complications such as arrhythmias, heart failure, and reinfarction in AMI patients, highlighting the potential severity of UTIs in AMI patients [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].Studies have demonstrated that UTIs related endotoxemia can elevate troponin levels and contribute to myocardial injury, further linking UTIs to poor cardiovascular outcomes[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite affecting 3\u0026ndash;10% of hospitalized AMI patients and being particularly common among hospitalized individuals, the specific impact of UTIs on in-hospital outcomes remains underexplored, with most research focusing on other infections[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In the present study, utilizing the National Inpatient Sample, we aimed to evaluate in-hospital outcomes in patients with AMI and concurrent UTIs. We assessed how UTIs may impact in-hospital mortality and complications during AMI hospitalizations, offering valuable insights into the impact of UTIs on AMI management and patient care.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Data Source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing data from the National Inpatient Sample (NIS), a publicly available all-payer inpatient healthcare database administered by the Agency for Healthcare Research and Quality, this study examined national estimates of hospital admissions in the United States between 2016 and 2021. The NIS contains a 20% stratified sample of all discharges from US hospitals, except rehabilitation and long-term acute care facilities, and represents hospitals from over 1000 [14]. Diagnoses and procedures were identified using ICD-10-CM codes. Since the NIS is a de-identified dataset, the study was exempt from institutional review board approval. The dataset used in this study, NIS, is publicly available and can be accessed from \u003cstrong\u003ewww.hcup-us.ahrq.gov\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Study Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with AMI were identified among hospitalized patients with either ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI), using ICD-10-CM codes. Individuals with missing data or aged under 18 years were excluded. The identified AMI patients were categorized into two groups: those with UTIs and those without \u003cstrong\u003e(Figure 1)\u003c/strong\u003e. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Study variables and outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe detailed the patient\u0026apos;s clinical and socioeconomic characteristics, encompassing demographics, insurance coverage, household income at the median level, determined by the patient\u0026apos;s ZIP code, and hospital attributes such as geographical setting (rural or urban) and hospital bed capacity (categorized as small, medium, and large), and teaching hospital status. Comorbidities were assessed using the Elixhauser Comorbidity Index[15]. Other clinically relevant comorbidities included smoking, dyslipidemia, previous myocardial infarction (MI), prior Percutaneous Coronary Intervention (PCI), prior Coronary Artery Bypass Grafting (CABG), diabetes, hypertension, obesity, and chronic renal failure (CRF). The types of AMI were classified as STEMI and NSTEMI. A full list of the ICD-10-CM codes used to identify these conditions is provided in \u003cstrong\u003eTable S1\u003c/strong\u003e. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome assessed was in-hospital mortality. Secondary outcomes included hospitalization complications and length of stay (LOS). Hospital complications consisted of cardiogenic shock (CS), acute kidney injury (AKI), gastrointestinal (GI) bleeding, and stroke. All outcomes were identified using ICD-10-CM codes, as detailed in \u003cstrong\u003eTable S1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 \u003c/strong\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe National Inpatient Sample (NIS) was utilized to produce weighted national estimates for tracking and analyzing healthcare outcomes. This study applied these weighted data to represent the full U.S. inpatient population, following guidelines set by the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality[16]. Patients\u0026rsquo; demographic and clinical characteristics were summarized using categorical data presented as percentages. In contrast, continuous data was shown as mean \u0026plusmn; standard deviation (SD) or interquartile range (IQR) based on their distribution. Continuous baseline variables were analyzed using a weighted linear regression model, and categorical variables were evaluated with a weighted chi-square test. Multivariate Analyses were adjusted for potential confounders to assess the independent relationship between UTIs and in-hospital outcomes, including mortality, complications, CS, AKI, GI bleeding, stroke, and LOS. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated to determine the strength and precision of these associations. Additionally, subgroup analyses were conducted to compare mortality rates among AMI patients with UTIs, stratified by gender, age (\u0026lt;65 and \u0026ge;65 years), race, STEMI and NSTEMI, hypertension, diabetes mellitus (DM), Chronic Renal Failure (CRF), percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). All statistical analyses were performed using EmpowerStats version 4.20 \u003cstrong\u003ehttp:// www.empowerstats.com\u003c/strong\u003e. Statistical significance for all tests was set at a two-tailed P value of less than 0.05. The figures were created using Adobe Illustrator https://adobe.com/products/illustrator and BioRender https://BioRender.com.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eFrom 2016 to 2021, among 760,177 AMI patients, 33,631 (4.4%) had a concurrent UTI. Of these, 7,206 (21.4%) were STEMI patients, and 26,425 (78.6%) were NSTEMI patients \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Baseline Characteristics of the Study Population\u003c/h2\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e presents the baseline characteristics and comorbidities of AMI patients with and without concurrent UTIs. In the unmatched cohort, patients with UTIs were significantly older (74.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1 years vs. 66.6\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3 years, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and predominantly female (66.9% vs. 35.9%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Patients with UTIs also exhibited a higher prevalence of CRF (33.0% vs. 20.3%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) but were less likely to be smokers (33.5% vs. 49.7%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) or have dyslipidemia (57.0% vs. 64.2%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, patients with UTIs had a lower prevalence of prior AMI (13.6% vs. 16.0%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and prior PCI (13.3% vs. 16.7%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). They were more frequently diagnosed with NSTEMI (78.6% vs. 69.9%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), admitted to urban non-teaching hospitals (22.2% vs. 20.4%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and relied more often on Medicare as their primary payer (78.1% vs. 56.0%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 In-Hospital Outcomes\u003c/h2\u003e \u003cp\u003eThe presence of UTIs was significantly associated with adverse in-hospital outcomes, including a 10% increase in in-hospital mortality (aOR 1.10, 95% CI 1.00\u0026ndash;1.10, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), a 60% higher risk of CS (aOR 1.60, 95% CI 1.50\u0026ndash;1.60, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and more than double the risk of ARF (aOR 2.40, 95% CI 2.40\u0026ndash;2.50, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, UTIs was associated with increased GI bleeding (aOR 1.80, 95% CI 1.70\u0026ndash;1.90, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and stroke (aOR 2.30, 95% CI 2.10\u0026ndash;2.50, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Patients with UTIs also experienced a significantly longer in-hospital stay (aOR 3.20, 95% CI 3.10\u0026ndash;3.30, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) \u003cb\u003e(Table\u0026nbsp;2) (\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Subgroup Analysis\u003c/h2\u003e \u003cp\u003eThe mortality risk for AMI patients with concurrent UTIs compared to those without UTIs across prespecified subgroups is presented in \u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e. Subgroups include stratification by gender, age (\u0026lt;\u0026thinsp;65 and \u0026ge;\u0026thinsp;65 years), race, STEMI, NSTEMI, hypertension, diabetes mellitus, CRF, prior PCI, and prior CABG. Although the association between UTIs and mortality risk remained significant across all subgroups, the highest mortality risk was observed among patients aged\u0026thinsp;\u0026le;\u0026thinsp;65, with a 2.60-fold increased risk (aOR: 2.60; 95% CI: 2.40\u0026ndash;2.90; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this national inpatient sample study of 760,177 patients with AMI, hospitalized in the United States from 2016 to 2021, we report the following findings. First, we observed that UTIs in patients with AMI are linked with a higher risk of adverse in-hospital outcomes, including mortality, CS, AKI, GI Bleeding, Stroke, and LOS. Second, we conducted subgroup analyses that the mortality impact was most pronounced in younger patients (\u0026le;\u0026thinsp;65 years), highlighting the potential severity of UTIs in this population. Third, these associations persisted across all examined subgroups, including STEMI/NSTEMI and patients with various comorbidities.\u003c/p\u003e \u003cp\u003eThis study advances the current literature by shifting the focus from UTIs as antecedent risk factors to their role as in-hospital complications following AMI. Unlike prior research, which has predominantly examined infections and UTIs as potential triggers of cardiovascular events, we specifically investigate UTIs acquired after AMI onset during the same hospitalization. This distinction is methodologically and clinically significant, highlighting infections not merely as precipitating factors but as complications that may exacerbate hospital outcomes. By analyzing a large, nationally representative inpatient dataset, our study addresses a critical knowledge gap, providing insights into the prognostic implications of UTIs developing during hospitalization for AMI, an understudied area in contemporary cardiovascular in-hospital outcomes research.\u003c/p\u003e \u003cp\u003eIn contrast, previous studies have explored UTIs and other infections as transient risk factors for AMI or stroke in community-based populations. For instance, Reeve et al. and Pedersen et al. utilized self-controlled case series designs to demonstrate a short-term increase in AMI or stroke risk following UTIs.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Similarly, Sims et al. reported temporal associations between infections and subsequent ischemic events, likely mediated by systemic inflammatory pathways.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] While most of the previous studies established infections as potential instigators of cardiovascular events, they did not evaluate UTIs as complications arising during AMI hospitalization, a key contribution of our work.\u003c/p\u003e \u003cp\u003eUTIs have been recognized as an important comorbidity in a hospitalized population, with significantly increased risk of systemic inflammation and multiorgan dysfunction [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Several studies have reported that UTIs prevalence rates ranged from 3\u0026ndash;10% across the patient populations studied, with notable differences depending on demographic or clinical characteristics[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Within the present study, the prevalence of UTIs among the AMI patients was 4% in accordance with existing research findings [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These results underscore the need for careful monitoring and timely management of UTIs in patients hospitalized with AMI.\u003c/p\u003e \u003cp\u003eThe significant association between UTIs and elevated in-hospital mortality is consistent with previous studies that have suggested systemic inflammation worsens cardiovascular outcomes [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. UTIs triggers inflammatory and thrombotic pathways, leading to endothelial dysfunction, plaque instability, and myocardial injury \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e These mechanisms likely explain the observed 10% increase in in-hospital mortality among AMI patients with UTIs [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In subgroup analysis, the highest mortality risk associated with UTIs was seen in patients\u0026thinsp;\u0026le;\u0026thinsp;65 years of age. This finding is contrary to the common belief that older populations are at higher risk and may reflect the lower baseline mortality risk in younger patients, implying that relative impact of UTIs is more pronounced in younger patients [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Younger patients may also present with more atypical symptoms, resulting in delayed diagnosis and treatment of AMI and UTIs and, therefore, worse outcomes [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe association between UTI and complications, such as CS, AKI, GI bleeding, and stroke, provides clear evidence of how systemic infection impacts AMI patients. The 60% increased risk of CS in UTIs patients reflects hemodynamic instability resulting from infection and systemic inflammation [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e AKI's more than twofold risk may be due to a combination of renal hypoperfusion, the nephrotoxic effect of antibiotics, and contrast agents administered for diagnostic and therapeutic purposes [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The increased risk of GI bleeding in patients with UTIs may be due to drugs such as anticoagulants, systemic inflammatory reactions, and a high likelihood of stress-related mucosal lesions in markedly ill people [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In addition, the increased risk of stroke likely arises from infection-dependent prothrombotic states, endothelial dysfunction, and potential arrhythmia, which can occur due to systemic inflammation[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e These findings emphasize the importance of increased awareness and attention to the management of these complications in patients with AMI and concurrent UTIs. Ultimately, patients with concurrent UTIs experienced longer hospital stays, likely related to the increased burden of complications, and required more intensive monitoring and treatment. Longer hospitalizations have not only put a burden on the healthcare system, but may also have increased the risk of additional hospital-acquired complications and continue to put patients into a cycle of poor outcomes [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe findings of this study have important clinical implications. First, the presence of UTIs in AMI patients should be a timely and aggressive management strategies to overcome the risk of adverse outcomes. This includes timely initiating of appropriate antibiotics, monitoring for signs of sepsis, and minimizing nephrotoxic exposures. Second, patients at higher risk, such as younger individuals and those with comorbidities like diabetes or CRF, may benefit from closer monitoring and personalized treatment approaches. Finally, the observed complications underscore the need for a collaborative approach to managing AMI patients with concurrent UTIs, including cardiologists, infectious disease specialists, and intensivists.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy Limitations and Strengths\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOur study has several strengths. To our knowledge, it is the first to investigate the impact of UTIs on in-hospital outcomes in a large, nationally representative cohort of AMI patients in the United States. We specifically examine the impact of UTIs acquired during hospitalization for AMI, highlighting them as in-hospital complications rather than pre-admission triggers of cardiovascular events, offering new insights not addressed in previous research. Using the NIS, a comprehensive all-payer database ensures that our findings are generalizable across diverse populations and healthcare settings. Moreover, the large sample size reduces the chances of type II errors and allows for comprehensive subgroup analyses to assess potential effect modifiers. However, this study is not without limitations. First, as with any study utilizing administrative data, depending on ICD-10 codes may introduce diagnostic errors or coding biases. Due to the lack of microbiological data in the NIS, we could not assess UTIs' severity, causative organisms, or antibiotic resistance profiles. Furthermore, information on specific treatment protocols was unavailable, such as the type and timing of antibiotics or catheter management. Lastly, our findings demonstrate associations rather than causal relationships as an observational study. Despite these limitations, the study addresses a critical knowledge gap by explaining the impact of UTIs on in-hospital outcomes in AMI patients. It highlights the need for enhanced clinical vigilance and preventative strategies. This provides a strong foundation for the potential therapeutic application of LBP in metabolic health management for elderly populations.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOur study highlights that UTIs are associated with significantly worse in-hospital outcomes in AMI patients, including higher mortality, increased complications, and prolonged hospital stays. These findings emphasize the need for prompt recognition and management of UTIs in this population to improve outcomes. The observed heightened mortality risk in younger patients warrants further investigation to understand the underlying mechanisms and guide targeted interventions. Future research should explore the long-term impact of UTIs on AMI outcomes and evaluate strategies to mitigate the adverse effects of infections in this high-risk group.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAMI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute Myocardial Infarction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUTIs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUrinary Tract Infections\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSTEMI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eST-Segment Elevation Myocardial Infarction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eNSTEMI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon-ST-Segment Elevation Myocardial Infarction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePCI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePercutaneous Coronary Intervention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCABG\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCoronary Artery Bypass Grafting\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eaOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGastrointestinal\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLOS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLength of Stay\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHCUP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealthcare Cost and Utilization Project\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCardiogenic Shock\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAKI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute Kidney Injury\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCKD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003echronic kidney disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAHRQ\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAgency for Healthcare Research and Quality\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eICD-10-CM/PCS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The NIS database (www.hcup-us.ahrq.gov) is publicly available and contains no identifiable information; the local institutional review board waived the requirement for informed consent under the Health Insurance Portability and Accountability Act.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are openly available in the National (Nationwide) Inpatient Sample (NIS) at \u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003ehttps://hcup-us.ahrq.gov/nisoverview.jsp\u003c/strong\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Natural Science Foundation of Ningxia Province (Project No. 2023AAC02071, 2022AAC03479), Open competition mechanism to select the best candidates for key research projects of Ningxia Medical University (Project No. XIKF230205), the Central government guided local science and technology project (Project No. 2022FRD05046) and the National Natural Science Foundation of China (82260086, 82060057).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGuangzhi Cong\u0026nbsp;contributed to the study design, supervision, critically revised the manuscript, and approved the final version for publication.\u003c/p\u003e\n\u003cp\u003eAbdul Rehman contributed formal analysis and drafted the original manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eXueping Ma, Ru Yan, and Shaobin Jia: Funding acquisition, Resources, and Supervision.\u003c/p\u003e\n\u003cp\u003eIsrael Gitangaza, Bo Shi, Rui Yan, Shizhe Fu, Kairu Wang, Baotong He, Aoqin Gu, and Yixuan Xu contributed to the critical revision of the manuscript for important intellectual content. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge HCUP data collection partners for making this study possible\u0026nbsp;\u003cstrong\u003e(https://www.hcup-us.ahrq.gov).\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMechanic, O.J., M. Gavin, and S.A. Grossman, \u003cem\u003eAcute Myocardial Infarction\u003c/em\u003e, in \u003cem\u003eStatPearls\u003c/em\u003e. 2025, StatPearls Publishing Copyright \u0026copy; 2025, StatPearls Publishing LLC.: Treasure Island (FL) ineligible companies. Disclosure: Michael Gavin declares no relevant financial relationships with ineligible companies. Disclosure: Shamai Grossman declares no relevant financial relationships with ineligible companies.\u003c/li\u003e\n \u003cli\u003eReed, G.W., J.E. Rossi, and C.P. Cannon, \u003cem\u003eAcute myocardial infarction.\u003c/em\u003e Lancet, 2017. \u003cstrong\u003e389\u003c/strong\u003e(10065): p. 197-210.\u003c/li\u003e\n \u003cli\u003eBaechli, C., et al., \u003cem\u003eAssociation of comorbidities with clinical outcomes in patients after acute myocardial infarction.\u003c/em\u003e Int J Cardiol Heart Vasc, 2020. \u003cstrong\u003e29\u003c/strong\u003e: p. 100558.\u003c/li\u003e\n \u003cli\u003eAl Lawati, H., B.M. Blair, and J. Larnard, \u003cem\u003eUrinary Tract Infections: Core Curriculum 2024.\u003c/em\u003e Am J Kidney Dis, 2024. \u003cstrong\u003e83\u003c/strong\u003e(1): p. 90-100.\u003c/li\u003e\n \u003cli\u003eMedina-Polo, J., K.G. Naber, and T.E. Bjerklund Johansen, \u003cem\u003eHealthcare-associated urinary tract infections in urology.\u003c/em\u003e GMS Infect Dis, 2021. \u003cstrong\u003e9\u003c/strong\u003e: p. 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Yu, \u003cem\u003eRole of inflammation and immune response in atherosclerosis: Mechanisms, modulations, and therapeutic targets.\u003c/em\u003e Hum Immunol, 2023. \u003cstrong\u003e84\u003c/strong\u003e(9): p. 439-449.\u003c/li\u003e\n \u003cli\u003eAlfaddagh, A., et al., \u003cem\u003eInflammation and cardiovascular disease: From mechanisms to therapeutics.\u003c/em\u003e Am J Prev Cardiol, 2020. \u003cstrong\u003e4\u003c/strong\u003e: p. 100130.\u003c/li\u003e\n \u003cli\u003eSims, J.B., et al., \u003cem\u003eUrinary tract infection in patients with acute coronary syndrome: a potential systemic inflammatory connection.\u003c/em\u003e Am Heart J, 2005. \u003cstrong\u003e149\u003c/strong\u003e(6): p. 1062-5.\u003c/li\u003e\n \u003cli\u003eVejpongsa, P., et al., \u003cem\u003eOutcomes of Acute Myocardial Infarction in Patients with Influenza and Other Viral Respiratory Infections.\u003c/em\u003e Am J Med, 2019. \u003cstrong\u003e132\u003c/strong\u003e(10): p. 1173-1181.\u003c/li\u003e\n \u003cli\u003eVallabhajosyula, S., et al., \u003cem\u003eTemporal Trends, Management and Outcomes of Acute Myocardial Infarction with Concomitant Respiratory Infections.\u003c/em\u003e Am J Cardiol, 2021. \u003cstrong\u003e150\u003c/strong\u003e: p. 1-7.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eIntroduction to the HCUP National Inpatient Sample; 2022.\u0026nbsp;\u003c/em\u003e\u003cem\u003eAccessed January 25, 2021.\u0026nbsp;\u003c/em\u003e\u003cem\u003ehttps://wwwhcup\u003c/em\u003e\u003cem\u003e‐usahrqgov/\u0026nbsp;\u003c/em\u003e\u003cem\u003enisoverviewjsp\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003evan Walraven, C., et al., \u003cem\u003eA modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data.\u003c/em\u003e Med Care, 2009. \u003cstrong\u003e47\u003c/strong\u003e(6): p. 626-33.\u003c/li\u003e\n \u003cli\u003eOstrominski, J.W., et al., \u003cem\u003eCoding Variation and Adherence to Methodological Standards in Cardiac Research Using the National Inpatient Sample.\u003c/em\u003e Front Cardiovasc Med, 2021. \u003cstrong\u003e8\u003c/strong\u003e: p. 713695.\u003c/li\u003e\n \u003cli\u003eReeve, N.F., et al., \u003cem\u003eMyocardial infarction and stroke subsequent to urinary tract infection (MISSOURI): protocol for a self-controlled case series using linked electronic health records.\u003c/em\u003e BMJ Open, 2022. \u003cstrong\u003e12\u003c/strong\u003e(9): p. e064586.\u003c/li\u003e\n \u003cli\u003ePedersen, E.M.J., et al., \u003cem\u003eSevere infections as risk factors for acute myocardial infarction: a nationwide, Danish cohort study from 1987-2018.\u003c/em\u003e Eur J Prev Cardiol, 2024.\u003c/li\u003e\n \u003cli\u003eSabih, A. and S.W. Leslie, \u003cem\u003eComplicated Urinary Tract Infections\u003c/em\u003e, in \u003cem\u003eStatPearls\u003c/em\u003e. 2025, StatPearls Publishing Copyright \u0026copy; 2025, StatPearls Publishing LLC.: Treasure Island (FL) ineligible companies. Disclosure: Stephen Leslie declares no relevant financial relationships with ineligible companies.\u003c/li\u003e\n \u003cli\u003eMengistu, D.A., et al., \u003cem\u003eIncidence of Urinary Tract Infection Among Patients: Systematic Review and Meta-Analysis.\u003c/em\u003e Inquiry, 2023. \u003cstrong\u003e60\u003c/strong\u003e: p. 469580231168746.\u003c/li\u003e\n \u003cli\u003eFoxman, B., \u003cem\u003eEpidemiology of urinary tract infections: incidence, morbidity, and economic costs.\u003c/em\u003e Am J Med, 2002. \u003cstrong\u003e113 Suppl 1A\u003c/strong\u003e: p. 5s-13s.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003e\u0026lt;iaim_2020_0712_08.pdf\u0026gt;.\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eSipil\u0026auml;, P.N., et al., \u003cem\u003eSevere Infection and Risk of Cardiovascular Disease: A Multicohort Study.\u003c/em\u003e Circulation, 2023. \u003cstrong\u003e147\u003c/strong\u003e(21): p. 1582-1593.\u003c/li\u003e\n \u003cli\u003eChen, C.Y., et al., \u003cem\u003eImpact of infection-related admission in patients with heart failure: a 10 years national cohort study.\u003c/em\u003e Sci Rep, 2023. \u003cstrong\u003e13\u003c/strong\u003e(1): p. 6941.\u003c/li\u003e\n \u003cli\u003eMedina-Leyte, D.J., et al., \u003cem\u003eEndothelial Dysfunction, Inflammation and Coronary Artery Disease: Potential Biomarkers and Promising Therapeutical Approaches.\u003c/em\u003e Int J Mol Sci, 2021. \u003cstrong\u003e22\u003c/strong\u003e(8).\u003c/li\u003e\n \u003cli\u003eHwang, S.Y., et al., \u003cem\u003eComparison of factors associated with atypical symptoms in younger and older patients with acute coronary syndromes.\u003c/em\u003e J Korean Med Sci, 2009. \u003cstrong\u003e24\u003c/strong\u003e(5): p. 789-94.\u003c/li\u003e\n \u003cli\u003eKhan, I.A., et al., \u003cem\u003eAtypical Presentations of Myocardial Infarction: A Systematic Review of Case Reports.\u003c/em\u003e Cureus, 2023. \u003cstrong\u003e15\u003c/strong\u003e(2): p. e35492.\u003c/li\u003e\n \u003cli\u003eSmeeth, L., et al., \u003cem\u003eRisk of Myocardial Infarction and Stroke after Acute Infection or Vaccination.\u003c/em\u003e New England Journal of Medicine, 2004. \u003cstrong\u003e351\u003c/strong\u003e(25): p. 2611-2618.\u003c/li\u003e\n \u003cli\u003ePoisson, S.N., S.C. Johnston, and S.A. Josephson, \u003cem\u003eUrinary Tract Infections Complicating Stroke.\u003c/em\u003e Stroke, 2010. \u003cstrong\u003e41\u003c/strong\u003e(4): p. e180-e184.\u003c/li\u003e\n \u003cli\u003eGoyal, A., et al., \u003cem\u003eAcute Kidney Injury\u003c/em\u003e, in \u003cem\u003eStatPearls\u003c/em\u003e. 2025, StatPearls Publishing Copyright \u0026copy; 2025, StatPearls Publishing LLC.: Treasure Island (FL) ineligible companies. Disclosure: Parnaz Daneshpajouhnejad declares no relevant financial relationships with ineligible companies. Disclosure: Muhammad Hashmi declares no relevant financial relationships with ineligible companies. Disclosure: Khalid Bashir declares no relevant financial relationships with ineligible companies.\u003c/li\u003e\n \u003cli\u003eMorales-Alvarez, M.C., \u003cem\u003eNephrotoxicity of Antimicrobials and Antibiotics.\u003c/em\u003e Advances in Chronic Kidney Disease, 2020. \u003cstrong\u003e27\u003c/strong\u003e(1): p. 31-37.\u003c/li\u003e\n \u003cli\u003eAl Aseri, Z., et al., \u003cem\u003eEvidence-based Management of Major Bleeding in Patients Receiving Direct Oral Anticoagulants: An Updated Narrative Review on the Role of Specific Reversal Agents.\u003c/em\u003e J Cardiovasc Pharmacol Ther, 2023. \u003cstrong\u003e28\u003c/strong\u003e: p. 10742484231202655.\u003c/li\u003e\n \u003cli\u003eCook, D.J., et al., \u003cem\u003eRisk Factors for Gastrointestinal Bleeding in Critically Ill Patients.\u003c/em\u003e New England Journal of Medicine, 1994. \u003cstrong\u003e330\u003c/strong\u003e(6): p. 377-381.\u003c/li\u003e\n \u003cli\u003ePaganini-Hill, A., et al., \u003cem\u003eInfection and Risk of Ischemic Stroke.\u003c/em\u003e Stroke, 2003. \u003cstrong\u003e34\u003c/strong\u003e(2): p. 452-457.\u003c/li\u003e\n \u003cli\u003eOh, S.E. and N.S. Parikh, \u003cem\u003eRecent Advances in the Impact of Infection and Inflammation on Stroke Risk and Outcomes.\u003c/em\u003e Curr Neurol Neurosci Rep, 2022. \u003cstrong\u003e22\u003c/strong\u003e(3): p. 161-170.\u003c/li\u003e\n \u003cli\u003eLagoe, R.J., P.E. Johnson, and M.P. Murphy, \u003cem\u003eInpatient hospital complications and lengths of stay: a short report.\u003c/em\u003e BMC Res Notes, 2011. \u003cstrong\u003e4\u003c/strong\u003e: p. 135.\u003c/li\u003e\n \u003cli\u003eCai, Y., et al., \u003cem\u003eThe impact of healthcare associated infections on mortality and length of stay in Singapore\u0026mdash;A time-varying analysis.\u003c/em\u003e Infection Control \u0026amp; Hospital Epidemiology, 2020. \u003cstrong\u003e41\u003c/strong\u003e(11): p. 1315-1320.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acute myocardial infarction, Urinary tract infections, National Inpatient Sample, In-Hospital Outcomes","lastPublishedDoi":"10.21203/rs.3.rs-6535029/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6535029/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003ePatients with acute myocardial infarction (AMI) who develop urinary tract infections (UTIs) are at a significantly higher risk of experiencing severe complications, but the impact of UTIs on in-hospital outcomes remains unclear. We aim to study the impact of UTIs on the in-hospital outcomes among patients with AMI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eData were extracted from the National Inpatient Sample database from 2016 to 2021 using ICD-10 codes to identify hospital admissions with a principal diagnosis of AMI with and without UTIs. The primary outcome was in-hospital mortality, while secondary outcomes included the incidence of cardiogenic shock, acute renal failure, gastrointestinal bleeding, stroke, and length of stay. Multivariate regression analyses were conducted to adjust for potential confounders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong 760,177 AMI patients, 33,631 (4.4%) had a concurrent UTIs. The presence of UTIs was significantly associated with adverse in-hospital outcomes, including a 10% increase in in-hospital mortality (aOR 1.10, 95% CI 1.00–1.10, P \u0026lt; 0.001), a 60% higher risk of cardiogenic shock (aOR 1.60, 95% CI 1.50–1.60, P \u0026lt; 0.001), and more than double the risk of acute renal failure (aOR 2.40, 95% CI 2.40–2.50, P \u0026lt; 0.001). Additionally, UTIs were associated with increased gastrointestinal bleeding (aOR 1.80, 95% CI 1.70–1.90, P \u0026lt; 0.001) and stroke (aOR 2.30, 95% CI 2.10–2.50, P \u0026lt; 0.001). Patients with UTIs also experienced a significantly longer in-hospital stay (aOR 3.20, 95% CI 3.10–3.30, P \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: AMI patients with UTIs are associated with significantly worse in-hospital outcomes, including increased mortality and higher rates of complications.\u003c/p\u003e","manuscriptTitle":"Impact of Urinary Tract Infections on In-Hospital Outcomes in Acute Myocardial Infarction: Insights from the National Inpatient Sample (2016-2021)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-30 14:56:27","doi":"10.21203/rs.3.rs-6535029/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12a91c1f-b12c-4d01-a322-b813dd5b52e6","owner":[],"postedDate":"May 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-05T10:55:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-30 14:56:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6535029","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6535029","identity":"rs-6535029","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}