Systemic inflammatory response syndrome in patients with acute obstructive upper tract urinary stone: a risk factor for urgent renal drainage and revisit to the emergency department

Spencer Larkin,Ramakrishna Venkatesh,Jeremy Johnson,Joel Vetter,Trisha Venkatesh

doi:10.1186/s12894-020-00644-z

Spencer Larkin, Ramakrishna Venkatesh + Show 3 more

Open Access

https://doi.org/10.1186/s12894-020-00644-z

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Abstract

BackgroundIn patients seen in the emergency department (ED) with acute stone obstruction many risk factors that indicate need for urgent renal drainage are known. However, in patients discharged from ED without renal drainage factors that can minimize revisit to the emergency department are not fully identified. We evaluated SIRS (systemic inflammatory response syndrome) as a risk factor for urgent renal drainage and revisit to the ED in patients with acute stone colic during their ED visit.MethodsRetrospective review was performed of patients presenting to a tertiary academic emergency department (ED) from an obstructing ureteral or UPJ stone with hydronephrosis confirmed on an abdominal and pelvic CT scan. Data evaluated over a 3-year period included stone size, presence of UTI, presence or absence of SIRS and other clinical variables as risk factors for urgent renal drainage and ED revisits.Results1983 patients with urolithiasis were seen at the ED and 649 patients had obstructive urolithiasis on CT scan. SIRS was diagnosed in 15% (99/649) patients. 54/99 (55%) patients with SIRS underwent urgent renal drainage compared to 99/550 (17%) in non-SIRS patients. In a multivariate analysis SIRS was a predictor of urgent intervention compared to non-SIRS patients (odds ratio 4.6, p < 0.05). SIRS was also associated with increased risk for revisits to the ED (6.9% with SIRS vs. 2.4% with no SIRS, odds ratio 2.9, p = 0.05).ConclusionsPresence of SIRS in obstructive urolithiasis patients was an independent risk factor of acute urologic intervention and revisits to the ED. A timely consultation with a urologist following discharge from ED for obstructive stone patients with SIRS who had no acute renal drainage may prevent revisit to the ED. Evaluation for SIRS in addition to other clinical risk factors should be considered while making management decision in patients with acute stone obstruction.

Highlights

In patients seen in the emergency department (ED) with acute stone obstruction many risk factors that indicate need for urgent renal drainage are known
Systemic inflammatory response syndrome (SIRS) was present in 15% (99/649) of patients seen at the ED with obstructive urolithiasis
SIRS was present in only 15% patients seen in our emergency department with obstructive urolithiasis

Summary

Introduction

In patients seen in the emergency department (ED) with acute stone obstruction many risk factors that indicate need for urgent renal drainage are known. A previous study identified some of the risk factors associated with the need for acute urological intervention in patients presenting with ureteral colic [2]. These included stone size of ≥5 mm, proximal ureteral stone, presence of nitrites or leucocyte esterase on chem-strip urinalysis, age over 50 years, tachycardia at triage and abnormal serum WBC count. In our cohort we studied risk factors at the initial evaluation in the emergency room including SIRS for an urgent need for renal drainage and patient disposition in patients presenting with an obstructive ureteral or UPJ stone. For patients who revisit the ED, pain is the most common variable in addition to symptoms of uti

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