# Gross hematuria in nonagenarians admitted to a urological ward: prevalence, predictors, and outcomes

## TL;DR

Gross hematuria is a common reason for hospital admission in people aged 90 and older, and it is linked to higher mortality and greater use of social services.

## Contribution

The study identifies risk factors for gross hematuria admissions in nonagenarians and highlights their impact on mortality and discharge outcomes.

## Key findings

- 42.3% of nonagenarians were admitted for gross hematuria.
- Antithrombotic therapy and bladder cancer history increased risk of hematuria-related admission.
- Hematuria patients had higher one-year mortality and lower survival time.

## Abstract

To describe the trajectories of nonagenarians admitted to a urological ward and to identify risk factors for admission due to gross hematuria (GH) and its impact on discharge status.

A retrospective cohort study of nonagenarians admitted to a tertiary care center between 2014 and 2022 was conducted. Data on demographics, comorbidities, medication, and outcomes were collected. Frailty was assessed via the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS). Multivariable Poisson regression was used to assess risk factors for GH-related admissions. Secondary endpoints included changes in discharge status and survival, analyzed using Kaplan-Meier and restricted mean survival time (RMST).

Among 317 patients (median age 92 yrs [IQR 91–94], 63.7% male), 134 (42.3%) were admitted for hematuria. Antithrombotic therapy (aRR = 1.40, 95% CI 1.02–1.92, p = 0.013) and history of bladder cancer (aRR = 1.46, 95% CI 1.08–1.96, p = 0.013) were significantly associated with hematuria-related admissions. Increased social service utilization was more frequent among hematuria patients (13.4% vs. 8.7%), reaching significance in sensitivity analysis (aRR = 2.17 95%CI 1.16–4.06, p = 0.02). One-year mortality was higher among hematuria patients (34.3% vs. 24.5%), with lower RMST (12 vs. 15 months). In-hospital mortality during the index admission was low across both groups. The CSHA-CFS had limited discriminative power to predict 1-year mortality (AUC = 0.59).

GH is a common reason for admission in nonagenarians and may indicate broader vulnerability. Geriatric assessment tools could aid in clinical decision-making and discharge planning. Future research should validate frailty-based risk stratification and address functional decline related to hospitalization in this population.

The online version contains supplementary material available at 10.1007/s00345-025-05975-w.