MP10-17 COMPARATIVE ANALYSIS OF OUTCOMES BETWEEN UROSEPSIS AND INTRA-ABDOMINAL SEPSIS PATIENTS

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I1 Apr 2018MP10-17 COMPARATIVE ANALYSIS OF OUTCOMES BETWEEN UROSEPSIS AND INTRA-ABDOMINAL SEPSIS PATIENTS Julie Stortz, Scott Brakenridge, Philip Efron, Lyle Moldawer, and Frederick Moore Julie StortzJulie Stortz More articles by this author , Scott BrakenridgeScott Brakenridge More articles by this author , Philip EfronPhilip Efron More articles by this author , Lyle MoldawerLyle Moldawer More articles by this author , and Frederick MooreFrederick Moore More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.363AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite QI efforts to reduce urosepsis (URS) in the surgical intensive care unit (SICU), most intensivists believe URS is relatively benign compared to other causes of SICU sepsis. Hence, we sought to compare the inflammatory response and outcomes of URS patients versus intra-abdominal sepsis (IAS) patients. METHODS This is a retrospective review of a 3-year prospective observational cohort study which included 246 surgical sepsis patients. Within this study, 25 URS and 95 IAS patients were identified. Sepsis screening and management was standardized and carried out using evidence-based protocols that emphasize timely administration of IV fluids and broad-spectrum antibiotics. Patient demographics, baseline characteristics, and sepsis-related data were recorded including the presence and type of sepsis source control procedure. Whole blood samples were collected at specific time points after sepsis onset and analyzed for biomarkers of inflammation and immunosuppression using Luminex. Clinical outcomes included in-hospital and post-discharge mortality, hospital and ICU length of stay, presence and severity of organ dysfunction, and discharge disposition. RESULTS There were no baseline differences in age, race, BMI, number of comorbidities, or APACHE II scores between URS and IAS patients. Likewise, there were no significant differences in CRP levels or cytokines (IL-6, IL-8, & IL-10) at 12 or 24 hours after sepsis onset. Sepsis severity was similar between cohorts. The most common causes of URS included ureterolithiasis with obstruction, complicated UTI, and recent instrumentation, whereas the most frequent etiologies of IAS were bowel perforations, ischemic colitis/enteritis, and pancreaticobiliary infections. As compared to URS patients, IAS patients were twice as likely to require a source control procedure, 66% of which involved an open surgery (vs 4% in URS group). Although inpatient and 12-month mortality did not significantly differ between groups, URS patients experienced shorter hospital and ICU lengths of stay (median 7 vs 18 days; 3 vs 9 days, respectively) and required fewer ventilator days. They were also more likely to be discharged to home (80% vs 44%), while IAS patients were often discharged to long-term care facilities (50% vs 20%)(p=0.01). CONCLUSIONS URS patients had shorter lengths of stay and were more likely to be discharged to home when compared to IAS patients. These findings cannot be explained by individual patient characteristics or variation in the initial inflammatory response, but may be attributed to differences in surgical source control. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e123-e124 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Julie Stortz More articles by this author Scott Brakenridge More articles by this author Philip Efron More articles by this author Lyle Moldawer More articles by this author Frederick Moore More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...