PREDICTING BLADDER CANCER AT THE EMERGENCY UNIT: THE IMPACT OF HEMOGLOBIN VALUE

Aim of the study Haematuria represents the most common symptom at presentation in patients with bladder Cancer (BCa). However, no study has tested the predictors of BCa in patients presenting with haematuria. This prospective study was aimed to assess the factors associated with the presence of BCa in patients presenting at our emergency unit due to gross-hematuria. Materials and methods All patients presenting at the emergency unit of our institution for their first episode of gross haematuria between January and December 2012 were evaluated. All clinical patient characteristics, including the ongoing antiplatelets and/or oral anticoagulative treatment, were recorded. Demographical, hematological and pharmacological data wa analyzed in order to predict the diagnosis of primary BCa. Results A total of 367 patients were registered at our emergency unit for gross-hematuria in 2012. Among them, 168 patients (45.8%) with previous history of bladder cancer (n=37, 22.0%), previous traumatic lesions (n=11, 6.5%) gross haematuria related to previous urological surgery (n= 70, 41.7%) or previous pelvic radiotherapy (n=50, 29.7 %), we excluded. Of the remaining 199 patients (54.2%), 30 (14.9%) were on oral anticoagulant therapy and 59 (29.4%) on antiplatelet therapy. After complete clinical assessment, the reason responsible for haematuria was documented to be: first episode of bladder cancer in 49 (24.6%), glomerulonephrites in 5 (2.5%), urinary tract infections in 19 (9.5%), prostatitis in 5 (2.5%), urethral pathology in 3 (1.5%), kidney cancer in 11 (5.5%), urolithiasis in 27 (13.6%), BPH in 53 (26.6%) and prostate cancer in17 (8.5%), respectively. At univariable analyses, hemoglobin value (HR:0.83; p=0.04) and age (HR:1.03; p Discussion The value of hemoglobin represented at MVA the only predictor of BCa. Other studies are designed in order to try to predict BCa in emergency room but no one take in considerations the Hemoglobin levels. Due to the paucity of improvement in the diagnosis improvement of BCa, Hemoglobin could represent a cheap indicator of first episode BCa. Conclusions Twenty-four percent of patients presenting to the emergency unit due to their first episode of gross haematuria was found with a primary BCa. The hemoglobin value at the time of patient presentation represents the only predictor of bladder cancer.