Department of Urology, University of Kentucky, Lexington, KY, USA.
Washington University in St. Louis, St. Louis, MO, USA.
BMC Urol. 2020 Jun 29;20(1):77. doi: 10.1186/s12894-020-00644-z.
In 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.
Retrospective 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.
1983 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).
Presence 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.
在急诊科（ED）就诊的急性结石梗阻患者中，许多提示需要紧急肾脏引流的危险因素是已知的。然而，在从 ED 出院的患者中，没有确定哪些因素可以最大限度地减少再次到急诊科就诊。我们评估了全身炎症反应综合征（SIRS）作为 ED 就诊的急性结石绞痛患者需要紧急肾脏引流和再次到 ED 的危险因素。
回顾性分析了 3 年来在一家三级学术急诊科就诊的因输尿管或肾盂连接部结石伴腹部和骨盆 CT 扫描证实的肾积水而出现梗阻的患者。评估的数据包括结石大小、是否存在尿路感染、是否存在 SIRS 以及其他临床变量作为紧急肾脏引流和 ED 再次就诊的危险因素。
ED 共收治了 1983 例尿路结石患者，649 例 CT 扫描显示有梗阻性尿路结石。15%（99/649）的患者诊断为 SIRS。与非 SIRS 患者（99/550，17%）相比，54/99（55%）的 SIRS 患者接受了紧急肾脏引流。多变量分析显示，与非 SIRS 患者相比，SIRS 是紧急干预的预测因素（比值比 4.6，p<0.05）。SIRS 也与再次到 ED 就诊的风险增加相关（SIRS 患者为 6.9%，无 SIRS 患者为 2.4%，比值比 2.9，p=0.05）。
在梗阻性尿路结石患者中，SIRS 的存在是急性泌尿外科干预和再次到 ED 就诊的独立危险因素。对于无急性肾脏引流且无 SIRS 的梗阻性结石患者，在 ED 出院后及时咨询泌尿科医生可能会防止再次到 ED 就诊。在对急性结石梗阻患者进行管理决策时，除了其他临床危险因素外，还应考虑 SIRS 的评估。
