Systemic inflammatory response syndrome in patients with acute obstructive upper tract urinary stone: a risk factor for urgent renal drainage and revisit to the emergency department

Abstract

Background In patients seen in the emergency department (ED) with acute stone obstruction many risk factors that indicate need for urgent renal drainage are known. However, in patients discharged from ED without renal drainage factors that can minimize revisit to the emergency department are not fully identified. We evaluated SIRS (systemic inflammatory response syndrome) as a risk factor for urgent renal drainage and revisit to the ED in patients with acute stone colic during their ED visit. Methods Retrospective review was performed of patients presenting to a tertiary academic emergency department (ED) from an obstructing ureteral or UPJ stone with hydronephrosis confirmed on an abdominal and pelvic CT scan. Data evaluated over a 3-year period included stone size, presence of UTI, presence or absence of SIRS and other clinical variables as risk factors for urgent renal drainage and ED revisits. Results 1983 patients with urolithiasis were seen at the ED and 649 patients had obstructive urolithiasis on CT scan. SIRS was diagnosed in 15% (99/649) patients. 54/99 (55%) patients with SIRS underwent urgent renal drainage compared to 99/550 (17%) in non-SIRS patients. In a multivariate analysis SIRS was a predictor of urgent intervention compared to non-SIRS patients (odds ratio 4.6, p < 0.05). SIRS was also associated with increased risk for revisits to the ED (6.9% with SIRS vs. 2.4% with no SIRS, odds ratio 2.9, p = 0.05). Conclusions Presence of SIRS in obstructive urolithiasis patients was an independent risk factor of acute urologic intervention and revisits to the ED. A timely consultation with a urologist following discharge from ED for obstructive stone patients with SIRS who had no acute renal drainage may prevent revisit to the ED. Evaluation for SIRS in addition to other clinical risk factors should be considered while making management decision in patients with acute stone obstruction.

Ureterocele Diagnosed With Point-of-Care Ultrasound

“…Our case is an example of how the implementation of point-of-care ultrasound can help differentiate between simple urinary tract infections versus complicated causes of pyelonephritis, more specifically the presence of hydronephrosis that might require urologic intervention if the patient has evidence of sepsis and genitourinary obstruction. In this young patient, with no prior history of urinary tract infections, ultrasound helped us by identifying a condition that if discharged with typical treatment for urinary tract infection could have caused the patient to return with a worsening condition due to the presence of a genitourinary tract obstruction and systemic inflammation [8]. As emergency medicine continues to move toward metrics such as door-to-antibiotic time and door-to-disposition time, the use of a tool that helps the clinician quickly rule out or rule in a diagnosis can be valuable.…”

Complicated supravesical obstruction in patients with urolithiasis: multifactorial analysis of risk factors

“…Нами были оценены факторы риска развития осложнённой СВО у пациентов с МКБ. В целом, уровень с осложнённым течением соответствовал или был выше данных, приведённых в литературе [9]. Относительно высокая встречаемость осложнённого течения МКБ, составляющих изначально сложную когорту пациентов типична для специализированных центров по лечению урологических заболеваний.…”

Factors influencing the flare of inflammatory markers after drainage of obstruction for patients with obstructive urosepsis

“…Last but not least, it has been demonstrated that presence of SIRS in obstructive urolithiasis patients was associated with increased risk for revisits to the emergency department 5 . A timely renal drainage according to Sepsis-2 de nition may contribute to decrease the probability of relapse caused by persistent obstruction.…”

“…Meanwhile, we require objective biomarkers to serve as indicators of response to the therapeutic intervention. A large armamentarium of serum sepsis biomarkers has been reported over the past years 4 , however, a majority of tests are experimental, costly and not commonly available in the emergent department in a timely manner 5 . Leukocytosis still plays a vital role in predicting the risk of sepsis and triggering surgical decompression of OUs 6 .…”