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We conducted a retrospective cross-sectional study to analyze risk factors for the development of severe sepsis or septic shock in obstructive urosepsis with stones for early identification of high-risk patients
.
Relevant research data was recently published in BMC Urology
.
Background Urinary sepsis (urosepsis) is a systemic inflammatory response caused by urinary tract infection, with rapid onset and progression
.
Once urosepsis develops into severe sepsis or septic shock, the fatality rate is as high as 28.
3%-41.
1%
.
Hoffmann et al found that 78% of urosepsis were caused by obstructive urolithiasis
.
There are few reports on prehospital risk factors from initial diagnosis to progression to more severe disease
.
Research methods Diagnostic criteria for urosepsis: (1) clinical symptoms caused by urinary tract infection; (2) systemic inflammatory response syndrome (at least two of the following: fever>38℃ or hypothermia <36℃; tachycardia >90 times/min; tachypnea >20 times/min or arterial blood carbon dioxide partial pressure <32 mmHG; leukocytosis >12×109/L or leukopenia <4×109/L or proportion of immature leukocytes ≥10%)
.
The 160 patients were divided into urosepsis group (99 cases), severe sepsis group (49 cases) and septic shock group (12 cases)
.
Severe sepsis is urosepsis combined with the following organ or dysfunction: (1) hypotension due to sepsis; (2) lactate higher than normal; (3) urine output < 0.
5 even with adequate fluid resuscitation ml/kg/h for at least 2 hours; (4) non-pneumonic acute lung injury with PaO2/FiO2<250 mmHg; (5) pulmonary acute lung injury with PaO2/FiO2<200 mmHg; (6) serum creatinine>176.
8 μmol /L (2.
0 mg/dL); (7) total bilirubin>34.
2 μmol/L (2.
0 mg/dL); (8) platelets <100000 μl; (9) coagulation dysfunction
.
Results A total of 160 patients were included in the study
.
Neutrophil-lymphocyte ratio (NLR), platelet count, albumin (ALB), serum creatinine (SCr), total bilirubin ( TBil), prothrombin time (PT), activated partial thromboplastin time (APPT), international normalized ratio (INR), procalcitonin (PCT), blood culture positive rate (P=0.
001) and other indicators were significantly different (Table 1)
.
Table 1 The results of multivariate logistic regression analysis of clinical data of patients revealed that age (P=0.
024), SCr (P=0.
000), and history of chronic kidney disease (CKI) (P=0.
010) were associated with the development of obstructive urosepsis with stones.
Independent risk factors for severe sepsis or septic shock (Table 2)
.
Table 2 Results of multivariate logistic regression analysis In this study, 63 (44.
06%) patients had positive urine culture results; 25 (29.
41%) patients had positive blood culture results
.
Escherichia coli was the most common pathogen in bacteremia (urine culture 65.
08%; blood culture 81.
48%)
.
Most patients in the study had gram-negative bacterial infections (84.
13% for urine cultures; 96.
29% for blood cultures)
.
Table 3 Pathogen composition Based on the results of multivariate logistic regression analysis, the researchers established ROC curves of three independent risk factors (age, SCr, history of CKI) to predict the development of obstructive urosepsis with stones to severe sepsis risk of septic shock or septic shock (see Figure 1 for the prediction model)
.
The results showed that the areas under the ROC curve of age, SCr, and CKI history were 0.
718, 0.
923, and 0.
611, respectively.
All three had good predictive functions, and SCr had higher predictive accuracy
.
Figure 1 ROC curve of age, SCr and history of CKI Conclusion This multicenter retrospective cross-sectional study confirmed that age ≥ 65, Scr ≥ 248 mol/L and history of CKI are associated with the progression of stone-obstructive urosepsis to severe sepsis independent risk factors for septic shock or septic shock
.
Identifying risk factors for urosepsis and treating them as early as possible is critical to preventing the development of urosepsis
.
Reference: Cao JD, Wang ZC, Wang YL et al.
Risk factors for progression of Urolith Associated with Obstructive Urosepsis to severe sepsis or septic shock.
BMC Urol.
2022 Mar 28;22(1):46.
Edited by: LR Review : Mia executes : LR