Department of Urology, Kyorin University School of Medicine, Shikawa 6-20-2, Mitaka, Tokyo, 181-8611, Japan.
BMC Urol. 2020 Mar 11;20(1):23. doi: 10.1186/s12894-020-00596-4.
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.
We 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.
Sixty-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.
Elevation of PCT and PSEP levels before treatment might predict the development of sepsis in patients with obstructive APN.
伴有尿路梗阻的急性肾盂肾炎（APN）常导致脓毒症。最近，根据新的 Sepsis-3 标准，使用序贯器官衰竭评估（SOFA）评分重新定义了脓毒症。我们研究了使用该新标准诊断伴有上尿路结石的梗阻性 APN 患者中脓毒症的预测因素。
我们回顾性评估了因梗阻性 APN 伴上尿路结石而入院的患者。在治疗梗阻性 APN 之前采集血和尿样本。治疗包括充分的抗菌治疗和紧急引流以解除肾集合系统的压力。我们使用新的 Sepsis-3 定义诊断脓毒症。我们通过多变量逻辑回归分析评估脓毒症的预测因素。
本研究共纳入 61 例患者。所有患者均接受了紧急引流，其中 11 例（18.0%）患者发生了脓毒症。脓毒症组和非脓毒症组在表现状态或合并症方面无显著差异。脓毒症组血小板计数和血清白蛋白水平明显低于非脓毒症组（p=0.001 和 p=0.016）。脓毒症组降钙素原（PCT）和前降钙素原（PSEP）水平明显高于非脓毒症组（p<0.001 和 p<0.001）。多变量分析显示，PCT 升高（OR=13.12，p=0.024）和 PSEP 升高（OR=13.13，p=0.044）是脓毒症的独立预测因素。
治疗前 PCT 和 PSEP 水平升高可能预测梗阻性 APN 患者发生脓毒症。
