Factores predictores de mortalidad en la sepsis urinaria con obstrucción ureteral

Abstract

PurposeThe aims of this study were to determine the clinical characteristics of patients with urinary sepsis associated to ureteral calculi admitted to the Intensive Care Unit (ICU), and to identify predictors of mortality in the first 24hours of admission. DesignA retrospective observational study covering a 16-year period (2006-2011) was carried out. SettingThe combined clinical/surgical ICU of a secondary-level University hospital. PatientsAll patients admitted to the ICU due to obstructive urinary sepsis. InterventionsNone. Main variablesWe analyzed general clinical and laboratory test and urological data. The diagnostic technique, affected side, decompression technique, isolated microorganism and antibiotic therapy used were also considered. The assessment of risk factors was performed by multiple logistic regression analysis. ResultsA total of 107 patients admitted to the ICU were included in the study, with a mortality rate of 19.6%. The diagnosis was mainly established by ultrasound, and the most commonly used decompression technique was retrograde JJ stenting. Microorganisms were isolated in 48.6% of the patients. In total, 20.6% of the patients had bacteremia. Multivariate analysis found age, acute renal failure and the use of vasoactive drugs administered continuously for the first 24hours of admission to be independently associated to mortality. ConclusionsAdvanced age, acute renal failure and the need for vasoactive drugs were associated to an increased risk of mortality in patients with urinary sepsis associated to upper urinary tract calculi.