Guide
Investigators conduct retrospective cross-sectional studies to analyze risk factors for the development of obstructive urinary sepsis with stones as severe sepsis or septic shock for early detection of high-risk patients. The relevant research data was recently published in BMC Urology.
background
Urosepsis refers to a systemic inflammatory response caused by a urinary tract infection, with rapid onset and progression. Once urinary sepsis develops into severe sepsis or septic shock, the fatality rate is as high as 28.3% to 41.1%. Hoffmann et al. found that 78% of urinary sepsis is caused by obstructive urinary stones. There are currently few reports of pre-hospital risk factors from the initial diagnosis of the disease to the progression of a more severe condition.
Research methodology
Diagnostic criteria for uremia: (1) clinical symptoms caused by urinary tract infection; (2) systemic inflammatory response syndrome (at least two of the following: fever > 38 °C or hypothermia < 36 °C; tachycardia > 90 beats/min; shortness of breath > 20 beats/min or arterial blood partial pressure of carbon dioxide < 32 mmHG; leukocytosis > 12×109/L or leukopenia <4×109/L or immature leukopenia ≥10%).
The 160 patients were divided into urine sepsis group (99 cases), severe sepsis group (49 cases) and septic shock group (12 cases).
Severe sepsis is urinary sepsis with the following organs or dysfunctions: (1) hypotension due to sepsis; (2) higher than normal lactate; (3) urine output < 0.5 ml/kg/h for at least 2 hours even with adequate fluid resuscitation; (4) PaO2/FiO234.2 μmol/L (2.0 mg/dL) ;(8) platelet <10,000 μl; (9) coagulation dysfunction.
Research results
The study included a total of 160 patients. There were significant differences in 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), and positive rate of blood culture (P=0.001) in the urine sepsis group, severe sepsis group, and septic shock group (Table 1).
Table 1 Clinical data of patients
The results of multiple logistic regression analysis revealed that age (P=0.024), SCr (P=0.000), and history of chronic kidney disease (CKI) (P=0.010) were independent risk factors for the development of obstructive urine sepsis with stones to severe sepsis or septic shock (Table 2).
Table 2 Results of multiple logistic regression analysis
In this study, 63 (44.06%) patients had positive urine culture results and 25 patients (29.41%) had positive blood culture results. E. coli is the most common pathogenic bacteria in bacteremia (65.08% in urine culture; 81.48% in blood culture). Most of the patients in the study were infected with Gram-negative bacteria (84.13% in urine cultures; 96.29% in blood cultures).
Table 3 Pathogen composition
Based on the results of the multipleistic regression analysis, the researchers established ROC curves for three independent risk factors (age, SCr, CKI history) to predict the risk of developing obstructive ureus sepsis with stones into severe sepsis or septic shock (see Figure 1 for the predictive model). The results showed that the area under the ROC curves of age, SCr and CKI history was 0.718, 0.923 and 0.611, respectively, and all three had better prediction functions, of which SCr had higher prediction accuracy.
Figure 1 ROC curve of age, SCr, and CKI history
conclusion
This multicenter retrospective cross-sectional study confirms that age ≥65, Scr≥248mol/L, and A history of CKI are independent risk factors for progression to severe sepsis or septic shock with stone-obstructive ureus sepsis. The detection of risk factors for uremia and its treatment as early as possible are essential to stop the development of urotemia.
参考文献：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.