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Uroseptic Shock Can Be Reversed by Early Intervention Based on Leukocyte Count 2 h Post-operation: Animal Model and Multicenter Clinical Cohort Study

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Abstract

This study investigated whether early intervention based on leukocyte count (WBC) of less than 2.85 × 109/L obtained within 2 h post-operatively may ameliorate the uroseptic shock induced by upper urinary tract endoscopic lithotripsy (UUTEL). Urosepsis was induced in 30 rabbits and assigned to three groups: Control-I, WBC-I, and Shock-I. Control-I: Non-intervention control. WBC-I: Immediate resuscitation when there was a drastic drop of WBC within 2 h post-operatively but without signs or symptoms of shock. Shock-I: Resuscitation only when there were signs or symptoms of shock. In total, 107 patients whose WBC were less than 2.85 × 109/L within 2 h after UUTEL were retrospectively analyzed. Patients were assigned into two groups based on the time of the intervention. Shock-II included 59 patients who were started on the resuscitation bundle when there were signs or symptoms of shock. WBC-II included 48 patients who were started immediately on the resuscitation bundle when the WBC decreased drastically. All Control-I rabbits developed shock within 72 h and died. None of the WBC-I rabbits developed shock and all survived for 72 h. In total, 60% of Shock-I died within 72 h. Overall, 43 patients in Shock-II and six patients in WBC-II experienced uroseptic shock. The average lengths of hospitalization for Shock-II and WBC-II were 17.8 ± 9.7 days and 7 ± 4.2 days, respectively. Six patients in the Shock-II and none in WBC-II died of the uroseptic shock. Early intervention based on WBC measured within 2 h post-operatively might avert the uroseptic shock induced by UUTEL.

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References

  1. O’Keeffe, N.K., A.J. Mortimer, P.A. Sambrook, and P.N. Rao. 1993. Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones. British Journal of Urology 72: 277–283.

    Article  PubMed  Google Scholar 

  2. Michel, M.S., L. Trojan, and J.J. Rassweiler. 2007. Complications in percutaneous nephrolithotomy. European Urology 51: 899–906 discussion 906.

    Article  PubMed  Google Scholar 

  3. Kallidonis, P., V. Panagopoulos, I. Kyriazis, and E. Liatsikos. 2016. Complications of percutaneous nephrolithotomy: classification, management, and prevention. Current Opinion in Urology 26: 88–94.

    Article  PubMed  Google Scholar 

  4. Wu, H., S. Zhu, S. Yu, G. Ding, J. Xu, T. Li, L. Qiao, Y. Chen, J. Yan, X. Cheng, S.P. Wan, and G. Li. 2015. Early drastic decrease in white blood count can predict uroseptic shock induced by upper urinary tract endoscopic lithotripsy: a translational study. The Journal of Urology 193: 2116–2122.

    Article  PubMed  Google Scholar 

  5. Tiselius, H.G. 2003. Epidemiology and medical management of stone disease. BJU International 91: 758–767.

    Article  PubMed  Google Scholar 

  6. Turney, B.W., J.M. Reynard, J.G. Noble, and S.R. Keoghane. 2012. Trends in urological stone disease. BJU International 109: 1082–1087.

    Article  PubMed  Google Scholar 

  7. Cindolo, L., P. Castellan, C.M. Scoffone, C.M. Cracco, A. Celia, A. Paccaduscio, L. Schips, S. Proietti, A. Breda, and G. Giusti. 2016. Mortality and flexible ureteroscopy: analysis of six cases. World Journal of Urology 34: 305–310.

    Article  PubMed  Google Scholar 

  8. Komori, M., H. Izaki, K. Daizumoto, M. Tsuda, Y. Kusuhara, H. Mori, J. Kagawa, K. Yamaguchi, Y. Yamamoto, T. Fukumori, M. Takahashi, H.O. Kanayama, M. Sakaki, H. Nakatsuji, T. Hamao, and H. Miura. 2015. Complications of flexible ureteroscopic treatment for renal and ureteral calculi during the learning curve. Urologia Internationalis 95: 26–32.

    Article  PubMed  Google Scholar 

  9. Youssef, R.F., A. Neisius, Z.G. Goldsmith, M. Ghaffar, M. Tsivian, R.H. Shin, F. Cabrera, M.N. Ferrandino, C.D. Scales, G.M. Preminger, and M.E. Lipkin. 2014. Clinical outcomes after ureteroscopic lithotripsy in patients who initially presented with urosepsis: matched pair comparison with elective ureteroscopy. Journal of Endourology 28: 1439–1443.

    Article  PubMed  Google Scholar 

  10. Koras, O., I.H. Bozkurt, T. Yonguc, T. Degirmenci, B. Arslan, B. Gunlusoy, O. Aydogdu, and S. Minareci. 2015. Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study. Urolithiasis 43: 55–60.

    Article  PubMed  Google Scholar 

  11. Shoshany, O., D. Margel, C. Finz, O. Ben-Yehuda, P.M. Livne, R. Holand, and D. Lifshitz. 2015. Percutaneous nephrolithotomy for infection stones: what is the risk for postoperative sepsis? A retrospective cohort study. Urolithiasis 43: 237–242.

    Article  PubMed  CAS  Google Scholar 

  12. Shankar-Hari, M., G.S. Phillips, M.L. Levy, C.W. Seymour, V.X. Liu, C.S. Deutschman, D.C. Angus, G.D. Rubenfeld, M. Singer, and for the Sepsis Definitions Task Force. 2016. Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 315: 775–787.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Levy, M.M., A. Artigas, G.S. Phillips, A. Rhodes, R. Beale, T. Osborn, J.L. Vincent, S. Townsend, S. Lemeshow, and R.P. Dellinger. 2012. Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study. The Lancet Infectious Diseases 12: 919–924.

    Article  PubMed  Google Scholar 

  14. Sen, V., I.H. Bozkurt, O. Aydogdu, T. Yonguc, S. Yarimoglu, P. Sen, O. Koras, and T. Degirmenci. 2016. Significance of preoperative neutrophil-lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy. The Kaohsiung Journal of Medical Sciences 32: 507–513.

    Article  PubMed  Google Scholar 

  15. Rivera, M., B. Viers, P. Cockerill, D. Agarwal, R. Mehta, and A. Krambeck. 2016. Pre- and postoperative predictors of infection-related complications in patients undergoing percutaneous nephrolithotomy. Journal of Endourology 30: 982–986.

    Article  PubMed  Google Scholar 

  16. Arora, S., P. Singh, P.M. Singh, and A. Trikha. 2015. Procalcitonin levels in survivors and nonsurvivors of sepsis: systematic review and meta-analysis. Shock 43: 212–221.

    Article  PubMed  CAS  Google Scholar 

  17. Avolio, M., P. Diamante, M.L. Modolo, R. De Rosa, P. Stano, and A. Camporese. 2014. Direct molecular detection of pathogens in blood as specific rule-in diagnostic biomarker in patients with presumed sepsis: our experience on a heterogeneous cohort of patients with signs of infective systemic inflammatory response syndrome. Shock 42: 86–92.

    Article  PubMed  CAS  Google Scholar 

  18. Wang, B., G. Chen, J. Zhang, J. Xue, Y. Cao, and Y. Wu. 2015. Increased neutrophil gelatinase-associated lipocalin is associated with mortality and multiple organ dysfunction syndrome in severe sepsis and septic shock. Shock 44: 234–238.

    Article  PubMed  CAS  Google Scholar 

  19. Samraj, R.S., B. Zingarelli, and H.R. Wong. 2013. Role of biomarkers in sepsis care. Shock 40: 358–365.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Kumar, A., C. Haery, B. Paladugu, A. Kumar, S. Symeoneides, L. Taiberg, J. Osman, G. Trenholme, S.M. Opal, R. Goldfarb, and J.E. Parrillo. 2006. The duration of hypotension before the initiation of antibiotic treatment is a critical determinant of survival in a murine model of Escherichia coli septic shock: association with serum lactate and inflammatory cytokine levels. The Journal of Infectious Diseases 193: 251–258.

    Article  PubMed  CAS  Google Scholar 

  21. Kang, M.J., T.G. Shin, I.J. Jo, K. Jeon, G.Y. Suh, M.S. Sim, S.Y. Lim, K.J. Song, and Y.K. Jeong. 2012. Factors influencing compliance with early resuscitation bundle in the management of severe sepsis and septic shock. Shock 38: 474–479.

    Article  PubMed  Google Scholar 

  22. Kumar, A., D. Roberts, K.E. Wood, B. Light, J.E. Parrillo, S. Sharma, R. Suppes, D. Feinstein, S. Zanotti, L. Taiberg, D. Gurka, A. Kumar, and M. Cheang. 2006. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine 34: 1589–1596.

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by Project 2016F81G2010012 Science and Technology Department of Zhejiang Province and the Project 2015KYB222 medical and health science and technology project of Zhejiang Province.

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    Authors and Affiliations

    1. Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, China

      Haiyang Wu, Zhenghui Wang, Shibin Zhu & Gonghui Li

    2. Department of Urology, The Second Hospital, Wenzhou University School of Medicine, Wenzhou, Zhejiang Province, China

      Dapang Rao

    3. Department of Urology, Jiangshan People’s Hospital, Jiangshan, Zhejiang Province, China

      Linyun Hu

    4. Department of Urology, Tongren Hospital of Peking University, Beijing, China

      Ludong Qiao

    5. Department of Urology, Ningbo First Hospital, Ningbo, Zhejiang Province, China

      Yue Chen

    6. Department of Urology, Shaoxing People’s Hospital, Shaoxing, Zhejiang Province, China

      Jiajun Yan

    7. Department of Urology, The Second Hospital of Jiaxing, Jiaxing, Zhejiang Province, China

      Xin Chen

    8. Department of Urology, First People’s Hospital of Xiaoshan, Hangzhou, Zhejiang, China

      Shaw P. Wan

    9. Stony Brook School of Medicine, University of New York, Stony Brook, NY, USA

      David A. Schulsinger

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    1. Haiyang Wu
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    Corresponding author

    Correspondence to Gonghui Li.

    Ethics declarations

    This study was reviewed and approved by the Institutional Ethics Committee of the Sir Run Run Shaw Hospital in Hangzhou, Zhejiang in China. The animal studies were approved by the Institutional Animal Care and Utilization Committee of Zhejiang University. This study protocol was approved by the Ethics Committees of all nine medical centers.

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    The authors declare that they have no conflict of interest.

    Additional information

    Haiyang Wu and Zhenghui Wang contributed equally to this work.

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    Wu, H., Wang, Z., Zhu, S. et al. Uroseptic Shock Can Be Reversed by Early Intervention Based on Leukocyte Count 2 h Post-operation: Animal Model and Multicenter Clinical Cohort Study. Inflammation 41, 1835–1841 (2018). https://doi.org/10.1007/s10753-018-0826-3

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    • DOI: https://doi.org/10.1007/s10753-018-0826-3

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