Urology - Original Paper

International Urology and Nephrology

, Volume 46, Issue 3, pp 493-497

First online:

Risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract

  • Jun KameiAffiliated withDepartment of Urology, The University of Tokyo Hospital
  • , Hiroaki NishimatsuAffiliated withDepartment of Urology, The University of Tokyo Hospital
  • , Tohru NakagawaAffiliated withDepartment of Urology, The University of Tokyo Hospital
  • , Motofumi SuzukiAffiliated withDepartment of Urology, The University of Tokyo Hospital
  • , Tetsuya FujimuraAffiliated withDepartment of Urology, The University of Tokyo Hospital
  • , Hiroshi FukuharaAffiliated withDepartment of Urology, The University of Tokyo Hospital
  • , Yasuhiko IgawaAffiliated withDepartment of Continence Medicine, Graduate School of Medicine, The University of Tokyo
  • , Haruki KumeAffiliated withDepartment of Urology, The University of Tokyo Hospital Email author 
  • , Yukio HommaAffiliated withDepartment of Urology, The University of Tokyo Hospital

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Abstract

Purpose

To assess the risk factors for septic shock in patients with acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract.

Methods

We retrospectively reviewed the records of 48 patients who underwent emergency drainage of the upper urinary tract for sepsis associated with acute obstructive pyelonephritis at our institute. Univariate and multivariate analyses were performed to identify the risk factors.

Results

Among 54 events of sepsis, we identified 20 events of septic shock requiring vasopressor therapy. Cases with shock were more likely than those without shock to have ureteral stone (70 vs 38 %, p = 0.024) and positive blood culture results (81 vs 28 %, p = 0.006). They received drainage significantly earlier than those without shock (1.0 vs 3.5 days, p < 0.001). Univariate analysis demonstrated that acute obstructive pyelonephritis by ureteral stone, rapid progression (the occurrence of symptoms to drainage ≤1 day), positive blood culture, leukocytopenia (<4,000/mm3), thrombocytopenia (<120,000/mm3), and prothrombin time international normalized ratio ≥1.20 were correlated with septic shock. Multivariate logistic regression analysis identified thrombocytopenia (p = 0.005) and positive blood culture (p = 0.040) as independent risk factors for septic shock.

Conclusions

Thrombocytopenia and positive blood culture were independent risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage. Thrombocytopenia would be practically useful as a predictor of septic shock.

Keywords

Acute obstructive pyelonephritis Septic shock Thrombocytopenia Ureteral drainage