qSOFA 评分能否预测梗阻合并感染性输尿管结石患者的 ICU 收治和结局？

Does qSOFA score predict ICU admission and outcomes in patients with obstructed infected ureteral stones?

机构信息

Department of Urology, Loma Linda University Health System, Loma Linda, California, USA.

出版信息

Can J Urol. 2021 Oct;28(5):10841-10847.

Abstract

INTRODUCTION

Obstructing stones with infection represent a true urologic emergency requiring prompt decompression. Historically the systemic inflammatory response syndrome (SIRS) criteria has been used to predict outcomes in patients with sepsis. The quick Sequential Organ Failure Assessment (qSOFA) score has been proposed as a prognostic factor in patients with acute pyelononephritis associated with nephrolithiasis. However there has been limited application of qSOFA to patients undergoing ureteral stenting with obstructive pyelonephritis. The purpose of this study was to evaluate the predictive value of the qSOFA score for postoperative outcomes following renal decompression in this patient population.

MATERIALS AND METHODS

A retrospective review was conducted at three medical centers within one academic institution to identify patients with obstructive pyelonephritis secondary to ureteral stones. All patients underwent emergent ureteral stent placement for decompression. The primary outcome was the predictive value of preoperative qSOFA score ≥ 2 for intensive care unit (ICU) admission postoperatively. Univariate analysis and multivariate regression analysis were performed to identify factors associated with postoperative outcomes, with p < 0.05 considered significant.

RESULTS

Of the 289 patients who had ureteral stents placed, 147 patients met inclusion criteria. Twenty-four (16.3%) patients required ICU admission and there were 3 (2%) mortalities, all of these within the ICU admission group. The sensitivity and specificity of the qSOFA score ≥ 2 for ICU admission was 70.8% and 79.5% respectively which outperformed SIRS criteria, which had a sensitivity and specificity of 100% and 33.6% respectively.

CONCLUSION

A preoperative qSOFA score ≥ 2 was a significant predictor for postoperative ICU admission in patients undergoing ureteral stent placement for obstructive pyelonephritis. The qSOFA score can be used to determine which patients will require ICU admission.

摘要

简介

伴有感染的梗阻性结石是一种真正的泌尿科急症，需要及时减压。历史上，全身性炎症反应综合征（SIRS）标准已被用于预测脓毒症患者的预后。快速序贯器官衰竭评估（qSOFA）评分已被提出作为与肾结石相关的急性肾盂肾炎患者的预后因素。然而，qSOFA 在接受输尿管支架置入术治疗梗阻性肾盂肾炎的患者中应用有限。本研究旨在评估 qSOFA 评分在该患者人群中肾减压术后对术后结局的预测价值。

材料与方法

在一个学术机构的三个医疗中心进行了回顾性研究，以确定继发于输尿管结石的梗阻性肾盂肾炎患者。所有患者均接受紧急输尿管支架置入术以减压。主要结局是术前 qSOFA 评分≥2 对术后入住重症监护病房（ICU）的预测价值。进行了单变量分析和多变量回归分析，以确定与术后结局相关的因素，p<0.05 被认为有统计学意义。

结果

在接受输尿管支架置入术的 289 名患者中，有 147 名患者符合纳入标准。24 名（16.3%）患者需要入住 ICU，其中 3 名（2%）死亡，均在 ICU 入院组。qSOFA 评分≥2 对 ICU 入院的敏感性和特异性分别为 70.8%和 79.5%，优于 SIRS 标准，其敏感性和特异性分别为 100%和 33.6%。