Patients' Poor Performance Status is an Independent Risk Factor for Urosepsis Induced by Kidney and Ureteral Stones

Overview

Journal Urolithiasis

Publisher Springer

Specialty Urology

Date 2021 Mar 23

PMID 33755744

Citations 5

Authors

Mika Kino

Takumi Hayashi

Daichi Hino

Takako Nakada

Hiroki Kitoh

Koichiro Akakura

Affiliations

Soon will be listed here.

Abstract

This study was aimed to identify the risk factors for urosepsis caused by kidney and ureteral stones. One hundred and nine patients who had kidney or ureteral stones and who were treated with trans-ureteral lithotripsy (TUL) at our institution from 2016 to 2020 were included. We investigated the risk factors for urosepsis caused by kidney or ureteral stones that occurred prior to TUL. Thirty patients (28%) had urosepsis prior to TUL. Patients were divided into a urosepsis group (n = 30, 28%) and a non-urosepsis group (n = 79, 72%). Patients' characteristics (gender, age, performance status [PS] score, presence of diabetes mellitus, and skeletal muscle mass), as well as their stone and urine characteristics (stone size, presence of obstructive ureteral stones, stone composition, and urine and stone cultures), were compared between the two groups. When compared to the non-urosepsis group, patients with urosepsis were more likely to be older (p < 0.001), female (p < 0.001), with lower skeletal muscle mass (p < 0.001) and with poor PSs (p < 0.001). For stone and urine characteristics, infection stones (p = 0.01), positive urine (p < 0.001) and stone culture (p = 0.007) were more often detected in patients with urosepsis. A multivariate analysis showed patients' poor PS to be an independent risk factor for urosepsis due to kidney and ureteral stones (OR = 15.7; 95% CI = 2.2-115, p = 0.007). Our study revealed that the most significant risk factor for urosepsis caused by kidney and ureteral stones was the patients' poor PS.

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References

Rudd K, Johnson S, Agesa K, Shackelford K, Tsoi D, Kievlan D . Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020; 395(10219):200-211. PMC: 6970225. DOI: 10.1016/S0140-6736(19)32989-7. View

van der Poll T, Opal S . Host-pathogen interactions in sepsis. Lancet Infect Dis. 2007; 8(1):32-43. DOI: 10.1016/S1473-3099(07)70265-7. View

Dreger N, Degener S, Ahmad-Nejad P, Wobker G, Roth S . Urosepsis--Etiology, Diagnosis, and Treatment. Dtsch Arztebl Int. 2016; 112(49):837-47. PMC: 4711296. DOI: 10.3238/arztebl.2015.0837. View

Raz R, Naber K, Raizenberg C, Rohana Y, Unamba-Oparah I, Korfman G . Ciprofloxacin 250 mg twice daily versus ofloxacin 200 mg twice daily in the treatment of complicated urinary tract infections in women. Eur J Clin Microbiol Infect Dis. 2000; 19(5):327-31. DOI: 10.1007/s100960050488. View

Wagenlehner F, Lichtenstern C, Rolfes C, Mayer K, Uhle F, Weidner W . Diagnosis and management for urosepsis. Int J Urol. 2013; 20(10):963-70. DOI: 10.1111/iju.12200. View

Wollin D, Joyce A, Gupta M, Wong M, Laguna P, Gravas S . Antibiotic use and the prevention and management of infectious complications in stone disease. World J Urol. 2017; 35(9):1369-1379. DOI: 10.1007/s00345-017-2005-9. View

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

Borghi L, Nouvenne A, Meschi T . Nephrolithiasis and urinary tract infections: 'the chicken or the egg' dilemma?. Nephrol Dial Transplant. 2012; 27(11):3982-4. DOI: 10.1093/ndt/gfs395. View

Abrahams H, Stoller M . Infection and urinary stones. Curr Opin Urol. 2002; 13(1):63-7. DOI: 10.1097/00042307-200301000-00011. View

10.

Reyner K, Heffner A, Karvetski C . Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection. Am J Emerg Med. 2016; 34(4):694-6. DOI: 10.1016/j.ajem.2015.12.068. View

11.

Lee J, Lee Y, Cho J . Risk factors of septic shock in bacteremic acute pyelonephritis patients admitted to an ER. J Infect Chemother. 2011; 18(1):130-3. DOI: 10.1007/s10156-011-0289-z. View

12.

Kalra O, Raizada A . Approach to a patient with urosepsis. J Glob Infect Dis. 2010; 1(1):57-63. PMC: 2840933. DOI: 10.4103/0974-777X.52984. View

13.

Margel D, Ehrlich Y, Brown N, Lask D, Livne P, Lifshitz D . Clinical implication of routine stone culture in percutaneous nephrolithotomy--a prospective study. Urology. 2006; 67(1):26-9. DOI: 10.1016/j.urology.2005.08.008. View

14.

Shigemura K, Tanaka K, Osawa K, Arakawa S, Miyake H, Fujisawa M . Clinical factors associated with shock in bacteremic UTI. Int Urol Nephrol. 2013; 45(3):653-7. DOI: 10.1007/s11255-013-0449-4. View

15.

Efstathiou S, Pefanis A, Tsioulos D, Zacharos I, Tsiakou A, Mitromaras A . Acute pyelonephritis in adults: prediction of mortality and failure of treatment. Arch Intern Med. 2003; 163(10):1206-12. DOI: 10.1001/archinte.163.10.1206. View

16.

Koga S, Arakaki Y, Matsuoka M, Ohyama C . Calculous pyelonephritis. Int Urol Nephrol. 1992; 24(2):109-12. DOI: 10.1007/BF02549636. View

17.

Kakinoki H, Tobu S, Kakinoki Y, Udo K, Uozumi J, Noguchi M . Risk Factors for Uroseptic Shock in Patients with Urolithiasis-Related Acute Pyelonephritis. Urol Int. 2017; 100(1):37-42. DOI: 10.1159/000481801. View

18.

Paonessa J, Gnessin E, Bhojani N, Williams Jr J, Lingeman J . Preoperative Bladder Urine Culture as a Predictor of Intraoperative Stone Culture Results: Clinical Implications and Relationship to Stone Composition. J Urol. 2016; 196(3):769-74. PMC: 5867897. DOI: 10.1016/j.juro.2016.03.148. View

19.

Yoshimura K, Utsunomiya N, Ichioka K, Ueda N, Matsui Y, Terai A . Emergency drainage for urosepsis associated with upper urinary tract calculi. J Urol. 2005; 173(2):458-62. DOI: 10.1097/01.ju.0000150512.40102.bb. View

20.

Yamamichi F, Shigemura K, Kitagawa K, Fujisawa M . Comparison between non-septic and septic cases in stone-related obstructive acute pyelonephritis and risk factors for septic shock: A multi-center retrospective study. J Infect Chemother. 2018; 24(11):902-906. DOI: 10.1016/j.jiac.2018.08.002. View