Gofrit Ofer N, Shapiro Amos, Rund Deborah, Verstandig Antony G, Landau Ezekiel H, Katz Ran, Shenfeld Ofer Z, Gdor Yehoshuah, Pode Dov
Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Am J Emerg Med. 2006 Jan;24(1):118-21. doi: 10.1016/j.ajem.2005.05.007.
Reactive thrombocytosis can be found in patients with different types of infections, including upper urinary tract infection (UTI). In this study, we determined whether thrombocytosis in patients with upper UTI is a random phenomenon or is related to complications associated with the UTI.
We reviewed the charts of patients admitted to the urology department with a diagnosis of upper UTI and thrombocytosis (platelet count >500 x 10(9)/L) in the years 1991 to 2003 (study group). Patients admitted to the urology department in the year 2003 with a diagnosis of upper UTI without thrombocytosis served as the control group.
The study group consisted of 83 patients admitted to the urology department with a diagnosis of upper UTI and thrombocytosis (mean platelet count, 593 x 10(9)/L; SD, 88; range, 501-949). The control group consisted of 99 patients. An obstructed kidney was found in 54 patients (65%) of the study group and in 18 patients (18%) of the control group (P < .00001). Perinephric abscess was found in 7 patients (8%) in the study group compared with none in the control group (P < .003). The positive predictive value of thrombocytosis for kidney obstruction or abscess in patients with upper UTI was 71%. Nephrectomy of a nonfunctioning infected kidney was required in 6 patients of the study group (7%) and 2 of the control group (P = .14). In 26 patients (31%) of the study group, the finding of thrombocytosis preceded the diagnosis of the complication (by a median period of 3 days). In these patients, thrombocytosis was essentially an early marker for the complication.
Thrombocytosis in a patient with upper UTI is not a random phenomenon. It is a marker of kidney obstruction or perinephric abscess. The finding of thrombocytosis in a patient with upper UTI should alert the attending physician to actively search for these complications. Cross-sectional imaging study (abdominal ultrasonography or computed tomography) should be performed.
反应性血小板增多症可见于包括上尿路感染（UTI）在内的不同类型感染患者。在本研究中，我们确定上尿路感染患者的血小板增多症是一种随机现象还是与UTI相关并发症有关。
我们回顾了1991年至2003年期间泌尿外科收治的诊断为上UTI且血小板增多症（血小板计数>500×10⁹/L）的患者病历（研究组）。2003年泌尿外科收治的诊断为上UTI但无血小板增多症的患者作为对照组。
研究组包括83例泌尿外科收治的诊断为上UTI且血小板增多症的患者（平均血小板计数，593×10⁹/L；标准差，88；范围，501 - 949）。对照组包括99例患者。研究组54例患者（65%）发现肾脏梗阻，对照组18例患者（18%）发现肾脏梗阻（P <.00001）。研究组7例患者（8%）发现肾周脓肿，而对照组未发现（P <.003）。上UTI患者血小板增多症对肾脏梗阻或脓肿的阳性预测值为71%。研究组6例患者（7%）和对照组2例患者需要对无功能的感染肾脏进行肾切除术（P =.14）。研究组26例患者（31%）中，血小板增多症的发现先于并发症的诊断（中位时间为3天）。在这些患者中，血小板增多症本质上是并发症的早期标志物。
上UTI患者的血小板增多症不是随机现象。它是肾脏梗阻或肾周脓肿的标志物。上UTI患者出现血小板增多症应提醒主治医师积极寻找这些并发症。应进行横断面影像学检查（腹部超声或计算机断层扫描）。
