title: Clinical characteristics and risk factors for septic shock in patients receiving emergency drainage for acute pyelonephritis with upper urinary tract calculi.
abstract: BACKGROUND
  Acute pyelonephritis (APN) is a common complication of ureteral obstruction caused by urolithiasis, and it can be lethal if it progresses to septic shock. We investigated the clinical characteristics of patients undergoing emergency drainage and assessed risk factors for septic shock.
  
  
  METHODS
  A retrospective study was performed of 98 patients (101 events) requiring emergency drainage at our urology department for obstructive APN associated with upper urinary tract calculi from January 2003 to January 2011. Clinical characteristics were summarized, and risk factors for septic shock were assessed by logistic regression analysis.
  
  
  RESULTS
  Objective evidence of sepsis was found in 64 (63.4%) events, and 21 events (20.8%) were categorized as septic shock. Ninety-six patients recovered, but 2 patients died of septic shock. Multivariate analysis revealed that age and the presence of paralysis were independent risk factors for septic shock.
  
  
  CONCLUSIONS
  APN associated with upper urinary tract calculi is a severe disease that should be treated with caution, particularly when risk factors are present.
authors.affiliation: Department of Urology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Fujita
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Nakazawa
authors.forename: Takuji
authors.initials: T
authors.lastname: Hayashi
authors.forename: Go
authors.initials: G
authors.lastname: Tanigawa
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Imamura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hosomi
authors.forename: Daiki
authors.initials: D
authors.lastname: Wada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fujimi
authors.forename: Seiji
authors.initials: S
authors.lastname: Yamaguchi
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004322:Drainage / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010243:Paralysis; D015995:Prevalence; D011704:Pyelonephritis / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology*; D014545:Urinary Calculi / Q000453:epidemiology*