Predictors of septic shock in obstructive acute pyelonephritis

Abstract

PurposeAcute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes serious conditions including sepsis and septic shock. We assessed the risk factors for septic shock in patients with obstructive APN associated with upper urinary tract calculi.MethodsWe retrospectively studied 69 patients with obstructive APN associated with upper urinary tract calculi who were admitted to our hospital. Emergency drainage for decompression of the renal collecting system was performed for empirical treatment in cases of failure of initial treatment and for severe cases. We assessed the risk factors for septic shock by multivariate logistic regression analysis.ResultsOverall, 45 patients (65.2 %) underwent emergency drainage and 23 (33.3 %) patients showed septic shock. Poor performance status and the presence of diabetes mellitus (DM) in the septic shock group were more common than in the non-septic shock group (p = 0.012 and p = 0.011, respectively). The platelet count and serum albumin level in the septic shock group were significantly lower than in the non-septic shock group (p = 0.002 and p = 0.003, respectively). Positive rates of midstream urine culture and blood culture in the septic shock group were significantly higher than in the non-septic shock group (p = 0.022 and p = 0.001, respectively). Multivariate analysis showed that decreases in the platelet count (OR 5.43, p = 0.014) and serum albumin level (OR 5.88, p = 0.023) were independent risk factors for septic shock.ConclusionPatients with obstructive APN associated with upper urinary tract calculi who have decreases in platelet count and serum albumin level should be treated with caution against the development of septic shock.

What Are the Predictive Factors of Severe Conditions in Acute Obstructive Pyelonephritis?

“…Original articles and their references were checked, and articles about pyelonephritis in pregnant or infant patients were excluded. Data from eight clinical studies discussing predictive factors for severe conditions and mortality in patients with acute obstructive pyelonephritis were summarized (Table 1) [6][7][8][9][10][11][12][13].…”

“…Systemic inflammatory response syndrome (SIRS) includes two or more of the following conditions: 1) body temperature higher than 38 o C or lower than 36 o C, 2) heart rate greater than 90 beats per minute, 3) tachypnea, as manifested by a respiratory rate greater than 20 breaths per minute or hyperventilation, as indicated by a partial CO 2 pressure less than 32 mmHg, and 4) white blood cell count greater than 12,000/mm 3 or less than 4,000/mm 3 , or more than 10% immature neutrophils, and SIRS is often used as the diagnosis of sepsis [15]. Of eight studies summarized in this study, four studies adopted SIRS as the definition of sepsis [7,[9][10][11], while the definitions of systemic inflammation response to infection were not specific or mentioned in the other four studies [6,8,12,13]. Severe sepsis and septic shock are generally defined as sepsis complicated by acute organ dysfunction and sepsis with acute circulatory failure characterized by persistent arterial hypotension despite adequate volume resuscitation, respectively [14].…”

“…Severe sepsis and septic shock are generally defined as sepsis complicated by acute organ dysfunction and sepsis with acute circulatory failure characterized by persistent arterial hypotension despite adequate volume resuscitation, respectively [14]. However, the specific criteria for septic shock are unclear, and varied among studies [7,8,11].…”

“…Of the seven single-institutional studies, five included only obstructive pyelonephritis with upper urinary tract calculi and one included obstructive pyelonephritis with any causes [6][7][8][9][10][11], and the other study targeted severe acute pyelonephritis and included non-obstructive cases [12].…”

“…Three studies defined a severe condition as septic shock, and one defined it as sepsis [6][7][8]11]. The need for intensive management was reported as a severe outcome in another study [10].…”