Urogenit Tract Infect.  2017 Dec;12(3):110-116. 10.14777/uti.2017.12.3.110.

Risk Factors of Sepsis and Factors Influencing the Decision to Perform Emergency Drainage in Obstructive Acute Pyelonephritis Secondary to Urinary Calculi

• Jung YH
• Jeong SC
• Baek M
• Ryu DS

• KMID: 2400219
• DOI: http://doi.org/10.14777/uti.2017.12.3.110

Abstract

PURPOSE
To investigate the risk factors for sepsis and analyze the criteria for emergency drainage in patients with obstructive acute pyelonephritis (APN) secondary to urinary calculi.
MATERIALS AND METHODS
We included 64 patients with obstructive APN secondary to urinary calculi. Patients were divided into two groups: the sepsis and non-sepsis groups. Independent risk factors for sepsis were also identified. Forty-three patients in the sepsis group were further divided into two subgroups: those who underwent emergency drainage and those who did not. A retrospective analysis was performed.
RESULTS
Of the 64 patients, 43 showed signs of sepsis. There was a lower lymphocyte count and lymphocyte percentage, as well as a higher C-reactive protein level and neutrophil-to-lymphocyte ratio (NLR) in the sepsis group compared with the non-sepsis group. Increased sepsis showed a statistically significant association with increased Charlson comorbidity index (CCI). Four out of 21 patients in the non-sepsis group underwent emergency drainage compared with 26 out of 43 patients in the sepsis group. Independent variables for sepsis in a multivariate logistic regression analysis showed positive blood culture, high NLR, and increased CCI score. Among sepsis patients, the likelihood of performing emergency drainage increased with higher creatinine, positive urine culture, and higher CCI score.
CONCLUSIONS
In patients with obstructive APN secondary to urinary calculi, a high CCI score were associated with a higher probability of progression to sepsis. In patients with higher creatinine and higher CCI scores, proactive treatment is usually necessary.

Keyword

Pyelonephritis; Sepsis; Urinary calculi; Nephrostomy, percutaneous; Ureteroscopy

MeSH Terms

C-Reactive Protein
Comorbidity
Creatinine
Drainage*
Emergencies*
Humans
Logistic Models
Lymphocyte Count
Lymphocytes
Nephrostomy, Percutaneous
Pyelonephritis*
Retrospective Studies
Risk Factors*
Sepsis*
Ureteroscopy
Urinary Calculi*
C-Reactive Protein
Creatinine

Reference

1.Hsu CY., Fang HC., Chou KJ., Chen CL., Lee PT., Chung HM. The clinical impact of bacteremia in complicated acute pyelonephritis. Am J Med Sci. 2006. 332:175–80.

2.Bone RC., Balk RA., Cerra FB., Dellinger RP., Fein AM., Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992. 101:1644–55.

3.American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992. 20:864–74.

4.Levy MM., Fink MP., Marshall JC., Abraham E., Angus D., Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003. 29:530–8.

5.Tambo M., Okegawa T., Shishido T., Higashihara E., Nutahara K. Predictors of septic shock in obstructive acute pyelonephritis. World J Urol. 2014. 32:803–11.

6.Brun-Buisson C. The epidemiology of the systemic inflammatory response. Intensive Care Med. 2000. 26(Suppl 1):S64–74.

7.Lim CH., Hwang JS., Kim DJ., Jang SH., Son JH., Cho DS, et al. Risk factors of sepsis in obstructive acute pyelonephritis associated with urinary tract calculi. Urogenit Tract Infect. 2015. 10:108–11.

8.Amano T., Matsui F., Takashima H., Takemae K. Analysis of patients with septic shock due to urosepsis brought on by ureteral calculi. Hinyokika Kiyo. 2003. 49:1–4.

9.Zahorec R. Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001. 102:5–14.

10.Yamanaka T., Matsumoto S., Teramukai S., Ishiwata R., Nagai Y., Fukushima M. The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in advanced gastric cancer. Oncology. 2007. 73:215–20.

11.Cho H., Hur HW., Kim SW., Kim SH., Kim JH., Kim YT, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother. 2009. 58:15–23.

12.Gomez D., Farid S., Malik HZ., Young AL., Toogood GJ., Lodge JP, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg. 2008. 32:1757–62.

13.Sarraf KM., Belcher E., Raevsky E., Nicholson AG., Goldstraw P., Lim E. Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg. 2009. 137:425–8.

14.Yamamoto Y., Fujita K., Nakazawa S., Hayashi T., Tanigawa G., Imamura R, et al. Clinical characteristics and risk factors for septic shock in patients receiving emergency drainage for acute pyelonephritis with upper urinary tract calculi. BMC Urol. 2012. 12:4.

15.Bossink AW., Groeneveld AB., Koffeman GI., Becker A. Prediction of shock in febrile medical patients with a clinical infection. Crit Care Med. 2001. 29:25–31.

16.Kamei J., Nishimatsu H., Nakagawa T., Suzuki M., Fujimura T., Fukuhara H, et al. Risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract. Int Urol Nephrol. 2014. 46:493–7.

17.Comarr AE., Kawaichi GK., Bors E. Renal calculosis of patients with traumatic cord lesions. J Urol. 1962. 87:647–56.

18.Angulo JC., Gaspar MJ., Rodríguez N., García-Tello A., Torres G., Núñez C. The value of C-reactive protein determination in patients with renal colic to decide urgent urinary diversion. Urology. 2010. 76:301–6.

19.Wagenlehner FM., Weidner W., Naber KG. Optimal management of urosepsis from the urological perspective. Int J Antimicrob Agents. 2007. 30:390–7.

20.Yoshimura K., Utsunomiya N., Ichioka K., Ueda N., Matsui Y., Terai A. Emergency drainage for urosepsis associated with upper urinary tract calculi. J Urol. 2005. 173:458–62.