Abstract
BackgroundAcute pyelonephritis (APN) with obstructive uropathy often causes sepsis. Recently, sepsis was redefined using the sequential organ failure assessment (SOFA) score, based on the new Sepsis-3 criteria. We investigated predictors for sepsis using this new definition in patients with obstructive APN associated with upper urinary tract calculi.MethodsWe retrospectively evaluated patients who were admitted to our hospital for treatment of obstructive APN associated with upper urinary tract calculi. Blood and urine samples were collected before treatment of obstructive APN. Treatment included adequate antimicrobial therapy and emergency drainage to decompress the renal collecting system. We diagnosed sepsis using the new Sepsis-3 definition. We assessed predictors for sepsis by multivariate logistic regression analysis.ResultsSixty-one patients were included in this study. Overall, all patients underwent emergency drainage, and 11 (18.0%) patients showed sepsis. There were no significant differences in performance status or comorbidities between sepsis and non-sepsis groups. Platelet count and serum albumin level were significantly lower in the sepsis group than in the non-sepsis group (p = 0.001 and p = 0.016, respectively). Procalcitonin (PCT) and presepsin (PSEP) levels were significantly higher in the sepsis group than in the non-sepsis group (p < 0.001 and p < 0.001, respectively). Multivariate analysis showed that PCT elevation (OR = 13.12, p = 0.024) and PSEP elevation (OR = 13.13, p = 0.044) were independent predictors for sepsis.ConclusionsElevation of PCT and PSEP levels before treatment might predict the development of sepsis in patients with obstructive APN.
Highlights
Acute pyelonephritis (APN) with obstructive uropathy often causes sepsis
A Japanese multicenter survey revealed that the rate of urosepsis based on SIRS criteria was 35.4% in patients with obstructive acute pyelonephritis (APN) secondary to urolithiasis [6]
A recent retrospective study showed that sequential organ failure assessment (SOFA) was more useful than SIRS for prediction of mortality in patients with APN associated with upper urinary tract calculi [7]
Summary
Acute pyelonephritis (APN) with obstructive uropathy often causes sepsis. Recently, sepsis was redefined using the sequential organ failure assessment (SOFA) score, based on the new Sepsis-3 criteria. We investigated predictors for sepsis using this new definition in patients with obstructive APN associated with upper urinary tract calculi. A Japanese multicenter survey revealed that the rate of urosepsis based on SIRS criteria was 35.4% in patients with obstructive acute pyelonephritis (APN) secondary to urolithiasis [6]. A recent retrospective study showed that SOFA was more useful than SIRS for prediction of mortality in patients with APN associated with upper urinary tract calculi [7]. Most previous studies of sepsis have discussed biomarkers for sepsis and septic shock [8]; to the best of our knowledge, there have been no reports regarding markers for sepsis, based on the new definitions, in patients with obstructive APN. We investigated the predictors for sepsis based on the new definitions in patients with obstructive APN associated with upper urinary tract calculi
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