分析 2 型糖尿病合并上尿路结石患者发生尿脓毒血症的危险因素：一项单中心回顾性研究。

Analysis of Risk Factors for Urosepsis in Patients with Type 2 Diabetes Complicated by Upper Urinary Tract Stones: A Single-Centre Retrospective Study.

机构信息

Department of Urology, The 964th Hospital of PLA Joint Logistic Support Force, 130062 Changchun, Jilin, China.

Nephropathy Endocrinology Department, The 964th Hospital of PLA Joint Logistic Support Force, 130062 Changchun, Jilin, China.

出版信息

Arch Esp Urol. 2024 Sep;77(8):875-881. doi: 10.56434/j.arch.esp.urol.20247708.123.

DOI:10.56434/j.arch.esp.urol.20247708.123

PMID:39385482

Abstract

BACKGROUND

Urosepsis represents a complication of upper urinary tract stones (UUTSs) in patients with type 2 diabetes mellitus (T2DM), thus necessitating a comprehensive understanding of risk factors. This single-centre retrospective study aimed to analyse the risk factors for urosepsis in this patient population.

METHODS

Clinical data of patients with UUTS and T2DM admitted from January 2015 to January 2024 were collected and retrospectively analysed. Laboratory parameters, including white blood cell (WBC) count, serum creatinine, urine culture, C-reactive protein and imaging findings were assessed. Stepwise backward selection and logistic regression analysis was used to explore the risk factors of urosepsis.

RESULTS

A total of 108 patients, including 56 patients complicated with urosepsis and 52 without urosepsis, were included. The urosepsis group exhibited significantly increased white blood cell count (15.75 ± 2.58 vs. 14.63 ± 2.76, = 0.031), colony-forming units per millilitre in urine culture (5000.46 ± 1200.56 vs. 4570.13 ± 1000.24, = 0.045), serum C-reactive protein levels (43.02 ± 12.36 vs. 38.54 ± 10.75, = 0.047), presence of hydronephrosis (82.14% vs. 63.46%, = 0.049) , ureteral stricture (46.43% vs. 25.00%, = 0.034), prevalence of Gram-negative bacteria (85.71% vs. 67.31%, = 0.042), antibiotic resistance (37.50% vs. 17.31%, = 0.034), and empirical antibiotic use (62.50% vs. 40.38%, = 0.035) compared with the non-urosepsis group. Gram-negative bacteria (odds ratio (OR) = 2.914, = 0.027), antibiotic resistance (OR = 2.867, = 0.022), renal hydronephrosis (OR = 2.648, = 0.031), urethral stricture (OR = 2.600, = 0.022) and antibiotic usage history (OR = 2.460, = 0.023) exhibited significant OR values, whereas white blood cell (WBC) count demonstrated a moderate OR value (OR = 1.175, = 0.034). These findings further underscore their potential to be reasonably predictive risk factors for urosepsis.

CONCLUSIONS

This study identified various risk factors associated with urosepsis in patients with T2DM and UUTS. Laboratory parameters, imaging findings and urinary tract infection characteristics were found to be significant contributors to the development of urosepsis in this patient population.

摘要

背景

尿脓毒症是 2 型糖尿病（T2DM）患者上尿路结石（UUTS）的并发症，因此需要全面了解其危险因素。本单中心回顾性研究旨在分析该患者人群中尿脓毒症的危险因素。

方法

收集 2015 年 1 月至 2024 年 1 月收治的 UUTS 和 T2DM 患者的临床资料，并进行回顾性分析。评估实验室参数，包括白细胞（WBC）计数、血清肌酐、尿培养、C 反应蛋白和影像学发现。采用逐步后退选择和逻辑回归分析探讨尿脓毒症的危险因素。

结果

共纳入 108 例患者，其中 56 例并发尿脓毒症，52 例无尿脓毒症。脓毒症组白细胞计数（15.75±2.58 vs. 14.63±2.76， = 0.031）、尿培养菌落形成单位/ml（5000.46±1200.56 vs. 4570.13±1000.24， = 0.045）、血清 C 反应蛋白水平（43.02±12.36 vs. 38.54±10.75， = 0.047）、肾盂积水（82.14% vs. 63.46%， = 0.049）、输尿管狭窄（46.43% vs. 25.00%， = 0.034）、革兰氏阴性菌（85.71% vs. 67.31%， = 0.042）、抗生素耐药性（37.50% vs. 17.31%， = 0.034）和经验性抗生素使用（62.50% vs. 40.38%， = 0.035）均显著高于非尿脓毒症组。革兰氏阴性菌（比值比（OR）=2.914， = 0.027）、抗生素耐药性（OR=2.867， = 0.022）、肾积水（OR=2.648， = 0.031）、输尿管狭窄（OR=2.600， = 0.022）和抗生素使用史（OR=2.460， = 0.023）的 OR 值显著升高，而白细胞（WBC）计数的 OR 值呈中度升高（OR=1.175， = 0.034）。这些发现进一步强调了它们作为合理预测尿脓毒症风险因素的潜力。