610 WHAT FACTORS CAN BETTER PREDICT THE INCIDENCE OF UROSEPSIS FOLLOWING AN ACUTE STONE EPISODE?

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 2010610 WHAT FACTORS CAN BETTER PREDICT THE INCIDENCE OF UROSEPSIS FOLLOWING AN ACUTE STONE EPISODE? John Mancini, Eliza Raymundo, Daniel Yong, Charles Scales, Michael Lipkin, Michael Ferrandino, Dorit Zilberman, Charles Gerardo, and Glenn Preminger John ManciniJohn Mancini More articles by this author , Eliza RaymundoEliza Raymundo More articles by this author , Daniel YongDaniel Yong More articles by this author , Charles ScalesCharles Scales More articles by this author , Michael LipkinMichael Lipkin More articles by this author , Michael FerrandinoMichael Ferrandino More articles by this author , Dorit ZilbermanDorit Zilberman More articles by this author , Charles GerardoCharles Gerardo More articles by this author , and Glenn PremingerGlenn Preminger More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.924AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sepsis from an obstructing stone is a relatively rare, but potentially lethal consequence of ureteral stones. Little is known about specific factors which are associated with development of urosepsis in patients who are initially deemed candidates for conservative management. Our objective was to identify clinical factors associated with the development of urosepsis after an initial trial of conservative therapy. METHODS A chart review of the past 3 years identified 1,402 patients seen in the Emergency Department (ED) with urolithiasis, of which 76 were admitted to the hospital with acute symptoms. Of the remaining patients placed on conservative therapy, 9 returned to the ED with urosepsis within a two week period. Upon review of inpatient records over the past 10 years, an additional 14 patients were identified, who had been admitted with urosepsis after being discharged from the ED. For these 23 patients, a matched case-control design was used to compare the septic patients with two age, sex and race matched control subjects. Univariate analysis with logistic regression was used to determine the association of specific factors related to urosepsis: recent history of fever, temperature, white blood (WBC) count, and urinalysis variables (leukocyte esterase, and nitrite positivity). RESULTS 0.68% of patients initially treated with conservative therapy, returned to the ED in urosepsis. The median age was 47 years and the majority of patients were female (65%). The median time for return to the ED was 2 days (range 1-14). When compared to the matched control group, the median WBC count was 10.7 vs. 9.0 x 109 cells per liter (OR=1.02, CI=0.889-1.192, p=0.699). The presence of subjective fever was not significantly associated (OR=2.917, CI=0.701-12.139, p=0.141), however temperature was significantly higher in the urosepsis patients, median 37.0° vs. 36.35°C (OR=4.08, CI=1.767-9.401, p=0.001). A temperature > 37.5°C was associated with a 7-fold increase in the risk of developing urosepsis (OR=7.64, CI=1.791-32.630, p=0.006). Neither the presence of leukocyte esterase or nitrites was associated with urosepsis. CONCLUSIONS The development of urosepsis from ureteral calculi is rare. Our study suggests that several reported predictors of infection were not associated with urosepsis. However, elevated temperature, particularly greater than 37.5°C is associated with a greater risk of urosepsis: even when patients are considered afebrile. Further evaluation in a larger cohort, possibly through a multi-centered approach, is required to confirm these findings. Durham, NC© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e240 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Mancini More articles by this author Eliza Raymundo More articles by this author Daniel Yong More articles by this author Charles Scales More articles by this author Michael Lipkin More articles by this author Michael Ferrandino More articles by this author Dorit Zilberman More articles by this author Charles Gerardo More articles by this author Glenn Preminger More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...