title: Risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract.
abstract: OBJECTIVE
  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/mm(3)), thrombocytopenia (<120,000/mm(3)), 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.
authors.affiliation: Department of Urology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kamei
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nishimatsu
authors.forename: Tohru
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Motofumi
authors.initials: M
authors.lastname: Suzuki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujimura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuhara
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Igawa
authors.forename: Haruki
authors.initials: H
authors.lastname: Kume
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007668:Kidney; D008297:Male; D008875:Middle Aged; D011704:Pyelonephritis / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D014513:Ureter; D014514:Ureteral Calculi / Q000150:complications*; D014517:Ureteral Obstruction / Q000150:complications*