Department of Urology, "Achillopoulio" General Hospital, Volos, Greece.
Department of Microbiology, "Achillopoulio" General Hospital, Volos, Greece.
J Endourol. 2020 Apr;34(4):516-522. doi: 10.1089/end.2019.0801. Epub 2020 Mar 17.
To investigate prognostic factors of outcome of acute obstructive pyelonephritis (AOP). Patients with AOP were prospectively evaluated and logistic regression analysis was applied to identify factors associated with the duration of hospital stay and occurrence of sepsis and septic shock. Based on CT scan findings, 62 patients were found to have AOP and subjected to emergency drainage. The main etiology of obstruction was lithiasis (70.9%). Double-J stent and percutaneous nephrostomy were introduced in 48 and 14 patients, respectively. Urosepsis and septic shock were diagnosed in 20 (32%) and 6 (9.7%) patients, respectively. None of the patients died of sepsis. In univariative analysis, older age, high neutrophils, increased serum creatinine, higher Charlson comorbidity index (CCI) score, any CCI score ≥1, diabetes mellitus (DM) longer operation time (OT), and multiresistant stains were risk factors of sepsis. Gender, type of drainage, laterality, white blood cell count, neutrophils rate >80%, C-reactive protein, and the presence of malignancy or lithiasis were not. Age, DM, and CCI score ≥1 were associated with prolonged hospitalization. None of the factors was associated with shock. In multivariative models, age (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.02-1.16, = 0.010), multiresistant strains (OR: 16.36, 95% CI: 1.97-135.71, = 0.006), OT >20 minutes (OR: 1.03, 95% CI: 1.00-1.07, = 0.048), and elevated creatinine (OR: 1.68, 95% CI: 1.001-2.84, = 0.049) were independent prognostic factors of sepsis, and DM (OR: 30.8%, CI: 8.86%-52.8%, = 0.007) was a prognostic factor of longer hospitalization. One-third of AOP patients will develop sepsis. Older age, elevated serum creatinine, longer OT presence of multiresistant strains, and DM are independent factors of worse outcome.
探讨急性梗阻性肾盂肾炎（AOP）患者预后的影响因素。
前瞻性评估 AOP 患者，采用 logistic 回归分析确定与住院时间延长及脓毒症和感染性休克发生相关的因素。根据 CT 扫描结果，62 例 AOP 患者行急诊引流，梗阻的主要病因是结石（70.9%）。48 例患者置入双 J 支架，14 例患者行经皮肾造瘘术。20 例（32%）和 6 例（9.7%）患者分别诊断为尿脓毒症和感染性休克。无患者死于脓毒症。单因素分析显示，年龄较大、中性粒细胞升高、血清肌酐升高、Charlson 合并症指数（CCI）评分较高、任何 CCI 评分≥1、糖尿病（DM）、手术时间较长（OT）、多重耐药菌为脓毒症的危险因素。性别、引流类型、侧别、白细胞计数、中性粒细胞率>80%、C 反应蛋白、恶性肿瘤或结石的存在均不是。年龄、DM 和 CCI 评分≥1 与住院时间延长相关。无任何因素与休克相关。多变量模型显示，年龄（比值比[OR]：1.09，95%置信区间[CI]：1.02-1.16， = 0.010）、多重耐药菌（OR：16.36，95%CI：1.97-135.71， = 0.006）、OT>20 分钟（OR：1.03，95%CI：1.00-1.07， = 0.048）和血肌酐升高（OR：1.68，95%CI：1.001-2.84， = 0.049）是脓毒症的独立预后因素，DM（OR：30.8%，CI：8.86%-52.8%， = 0.007）是住院时间延长的预后因素。AOP 患者中有 1/3 会发生脓毒症。年龄较大、血肌酐升高、OT 时间较长、存在多重耐药菌和 DM 是预后不良的独立因素。
