Abstract

Background: Purple urine bag syndrome (PUBS) is rarely seen in clinical practice. Although it is most commonly seen in the elderly, we wanted to understand how this syndrome differs between the elderly and non-elderly.

Methods: PubMed articles were searched from 1980 October to 2016 August; 106 articles reported on PUBS. Among them, 174 PUBS cases were described. We excluded 58 cases and 116 PUBS cases were enrolled in this study. The chi-square test was used for statistical analysis, and a p value less than 0.05 (2- tailed) was considered to denote statistical significance.

Results: There were 47 men and 69 women enrolled in this study with a mean age of 75.6±12.8 years (mean±SD). Of these, 98 (84.5%) cases were found in elderly patients. The elderly PUBS patients presented with fever and shock less frequently than did non-elderly PUBS patients (8.2% vs. 27.8%, p = 0.02; 6.1% vs. 22.2%, p = 0.03). The overall mortality rate in PUBS was 6.8%. Elderly PUBS patients had relatively lower mortality rates, but the difference was not statistically significant (5.1% vs. 16.7%, p = 0.08).

Conclusion: PUBS in the elderly is associated with significantly lower rates of urosepsis symptoms, such as fever and hypotension. Although PUBS used to be considered a benign presentation in the majority of indwelling catheterized patients, for clinically afebrile and normotensive elderly patients, physicians should refer to patient's condition (consciousness, appetite), biomarker (C-reactive protein, and pro-calcitonin) to prevent from mortality in clinical practice.