Procalcitonin determined at emergency department as an early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi

Abstract

Introduction:To investigate the role of initial procalcitonin (PCT) level as an early predictor of septic shock for the patient with sepsis induced by acute pyelonephritis (APN) secondary to ureteral calculi.Materials and Methods:The data from 49 consecutive patients who met criteria of sepsis due to APN following ureteral stone were collected and divided into two groups: with (n=15) or without (n=34) septic shock. The clinical variables including PCT level for this outcome were retrospectively compared by univariate analysis, followed by multivariable logistic regression model.Results:All subjects had hydronephrosis, and were hospitalized with the mean of 11.8 days (3–42 days). The mean size of the ureteral stones was 7.5mm (3–30mm), and 57% were located in upper ureter. At univariate analysis, patients with septic shock were significantly older, a higher proportion had hypertension, lower platelet count and serum albumin level, higher CRP and PCT level, and higher positive blood culture rate. Multivariate models indicated that lower platelet count and higher PCT level are independent risk factors (p=0.043 and 0.046, respectively). In ROC curve, the AUC was significantly wider in PCT (0.929), compared with the platelet count (0.822, p=0.004). At the cut-off of 0.52ng/mL, the sensitivity and specificity were 86.7% and 85.3%.Conclusion:Our study demonstrated elevated initial PCT levels as an early independent predictor to progress into septic shock in patients with sepsis associated with ureteral calculi.

Glycated Hemoglobin < 6.5% Is Associated With Uroseptic Shock in Diabetic Patients With Urinary Tract Infection

“…Previous studies have demonstrated that 26-33% of patients with bacteremic UTI present with uroseptic shock (32, 33) (35.2% in Taiwan) (34). Moreover, consistent with the present study, Ko et al indicated that higher bacteremia rates were observed in patients with uroseptic shock induced by urolithiasis-related acute pyelonephritis (35), and bacteremia was identified as an independent risk factor for septic shock in patients with acute obstructive pyelonephritis (36). Consequently, prolonged duration of antibiotic therapy should be considered in diabetic patients with bacteremic UTI and in patientswith septic shock due to the existence of bacteremia accompanied with more serious manifestations.…”

Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy

“…Study of Young et al [ 31 ] evaluated the ability of PCT as an early detector of septic shock in patients with acute pyelonephritis secondary to ureteral calculi. They considered 49 patients and divided them into 2 groups: with and without septic shock.…”

A diagnostic algorithm for detection of urinary tract infections in hospitalized patients with bacteriuria: The “Triple F” approach supported by Procalcitonin and paired blood and urine cultures

“…Obtaining PCT might also be a useful prognostic tool. Although a single value PCT does not correlate well with severity of sepsis, mortality or outcome in ED patients with pyelonephritis [ 46 , 47 ], initial PCT levels are a predictor of progression to septic shock in patients with acute pyelonephritis [ 48 ].…”