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20.07.2023 | Original Article

Clinical and time-related predictors of sepsis in patients with obstructive uropathy due to ureteral stones in the emergency setting

verfasst von: Carlo Silvani, Carolina Bebi, Elisa De Lorenzis, Gianpaolo Lucignani, Matteo Turetti, Letizia Maria Ippolita Jannello, Stefano Paolo Zanetti, Fabrizio Longo, Giancarlo Albo, Andrea Salonia, Emanuele Montanari, Luca Boeri

Erschienen in: World Journal of Urology | Ausgabe 9/2023

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Abstract

Purpose

Well-defined clinical predictors of sepsis after upper tract drainage for obstructive uropathy due to ureteral stones are needed. We aim to determine whether sepsis after decompression of the upper urinary tract may be predicted by clinical and time-related factors, specifically delay time from symptom onset to hospital presentation (StH) and from hospital presentation to surgical decompression (HtD).

Methods

In this single-center retrospective study, data from 196 consecutive patients presenting to the emergency department for obstructive uropathy due to ureteral stones and submitted to surgical decompression were evaluated. Postoperative sepsis was defined as an acute increase in ≥ 2 SOFA points and documented blood or urine cultures.

Results

Median StH and HtD were 24 (6–48) and 17 (10–30) hours, respectively. Thirty-three (16.8%) patients developed sepsis. Septic patients were more frequently female (75.8% vs. 37.4%, p < 0.001), had higher preoperative max body temperature (p < 0.001), white blood cells (WBC) count (p < 0.01), C-reactive protein (CRP) values (p < 0.001) and larger stone diameter (7.2 vs. 6 mm, p = 0.02). StH and HtD did not differ according to sepsis status. Time for WBC normalization and CRP halving were longer for septic patients (all p < 0.02). At multivariable logistic regression analysis, max body temperature ≥ 38 °C (OR 21.5; p < 0.001), female gender (OR 3.6; p = 0.02) and higher CRP (OR 1.1; p < 0.001) were independently associated with sepsis status.

Conclusion

Clinical and laboratory parameters are associated with an increased risk of sepsis after decompression. StH and HtD timing are not associated with higher sepsis rates. In selected patients, urinary decompression could be delayed or primary ureteroscopy could be considered.

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Sands KE, Bates DW, Lanken PN, Graman PS, Hibberd PL, Kahn KL et al (1997) Epidemiology of sepsis syndrome in 8 academic medical centers. JAMA 278:234–240. https://doi.org/10.1001/jama.1997.03550030074038CrossRefPubMed

Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273:117–123CrossRefPubMed

Cek M, Tandoğdu Z, Wagenlehner F, Tenke P, Naber K, Bjerklund-Johansen TE (2014) Healthcare-associated urinary tract infections in hospitalized urological patients—a global perspective: results from the GPIU studies 2003–2010. World J Urol 32:1587–1594. https://doi.org/10.1007/s00345-013-1218-9CrossRefPubMed

Wagenlehner FME, Weidner W, Naber KG (2007) Optimal management of urosepsis from the urological perspective. Int J Antimicrob Agents 30:390–397. https://doi.org/10.1016/j.ijantimicag.2007.06.027CrossRefPubMed

Borofsky MS, Walter D, Shah O, Goldfarb DS, Mues AC, Makarov DV (2013) Surgical decompression is associated with decreased mortality in patients with sepsis and ureteral calculi. J Urol 189:946–951. https://doi.org/10.1016/j.juro.2012.09.088CrossRefPubMed

Kozyrakis D, Kratiras Z, Soukias G, Chatzistamou S-E, Zarkadas A, Perikleous S et al (2020) Clinical outcome and prognostic factors of sepsis, septic shock and prolonged hospitalization, of patients presented with acute obstructive pyelonephritis. J Endourol 34:516–522. https://doi.org/10.1089/end.2019.0801CrossRefPubMed

Yoshimura K, Utsunomiya N, Ichioka K, Ueda N, Matsui Y, Terai A (2005) Emergency drainage for urosepsis associated with upper urinary tract calculi. J Urol 173:458–462. https://doi.org/10.1097/01.ju.0000150512.40102.bbCrossRefPubMed

Bebi C, Fulgheri I, Spinelli MG, Turetti M, Lievore E, Ripa F et al (2022) Development of a novel clinical and radiologic risk score to predict septic complications after urinary decompression in patients with obstructive uropathy. J Endourol 36:360–368. https://doi.org/10.1089/end.2021.0148CrossRefPubMed

Boeri L, Fulgheri I, Palmisano F, Lievore E, Lorusso V, Ripa F et al (2020) Hounsfield unit attenuation value can differentiate pyonephrosis from hydronephrosis and predict septic complications in patients with obstructive uropathy. Sci Rep 10:18546. https://doi.org/10.1038/s41598-020-75672-8CrossRefPubMedPubMedCentral

10.

Haas CR, Li G, Hyams ES, Shah O (2020) Delayed decompression of obstructing stones with urinary tract infection is associated with increased odds of death. J Urol 204:1256–1262. https://doi.org/10.1097/JU.0000000000001182CrossRefPubMed

11.

Blackwell RH, Barton GJ, Kothari AN, Zapf MAC, Flanigan RC, Kuo PC et al (2016) Early intervention during acute stone admissions: revealing “The Weekend Effect” in urological practice. J Urol 196:124–130. https://doi.org/10.1016/j.juro.2016.01.056CrossRefPubMedPubMedCentral

12.

Salute M della. Manuale ICD-9-CM versione italiana 2007 n.d. https://www.salute.gov.it/portale/documentazione/p6_2_2_1.jsp?lingua=italiano&id=2251 (accessed December 3, 2022).

13.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383. https://doi.org/10.1016/0021-9681(87)90171-8CrossRefPubMed

14.

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al (2016) The Third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315:801–810. https://doi.org/10.1001/jama.2016.0287CrossRefPubMedPubMedCentral

15.

Baboudjian M, Gondran-Tellier B, Di Bisceglie M, Abdallah R, Michel F, Sichez PC et al (2021) The prognostic value of serum procalcitonin in acute obstructive pyelonephritis. World J Urol 39:1583–1589. https://doi.org/10.1007/s00345-020-03353-2CrossRefPubMed

Titel: Clinical and time-related predictors of sepsis in patients with obstructive uropathy due to ureteral stones in the emergency setting
verfasst von: Carlo Silvani
Carolina Bebi
Elisa De Lorenzis
Gianpaolo Lucignani
Matteo Turetti
Letizia Maria Ippolita Jannello
Stefano Paolo Zanetti
Fabrizio Longo
Giancarlo Albo
Andrea Salonia
Emanuele Montanari
Luca Boeri
Publikationsdatum: 20.07.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 9/2023
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04513-w

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Clinical and time-related predictors of sepsis in patients with obstructive uropathy due to ureteral stones in the emergency setting