title: Predictors of septic shock in obstructive acute pyelonephritis.
abstract: OBJECTIVE
  Acute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes serious conditions including sepsis and septic shock. We assessed the risk factors for septic shock in patients with obstructive APN associated with upper urinary tract calculi.
  
  
  METHODS
  We retrospectively studied 69 patients with obstructive APN associated with upper urinary tract calculi who were admitted to our hospital. Emergency drainage for decompression of the renal collecting system was performed for empirical treatment in cases of failure of initial treatment and for severe cases. We assessed the risk factors for septic shock by multivariate logistic regression analysis.
  
  
  RESULTS
  Overall, 45 patients (65.2 %) underwent emergency drainage and 23 (33.3 %) patients showed septic shock. Poor performance status and the presence of diabetes mellitus (DM) in the septic shock group were more common than in the non-septic shock group (p = 0.012 and p = 0.011, respectively). The platelet count and serum albumin level in the septic shock group were significantly lower than in the non-septic shock group (p = 0.002 and p = 0.003, respectively). Positive rates of midstream urine culture and blood culture in the septic shock group were significantly higher than in the non-septic shock group (p = 0.022 and p = 0.001, respectively). Multivariate analysis showed that decreases in the platelet count (OR 5.43, p = 0.014) and serum albumin level (OR 5.88, p = 0.023) were independent risk factors for septic shock.
  
  
  CONCLUSIONS
  Patients with obstructive APN associated with upper urinary tract calculi who have decreases in platelet count and serum albumin level should be treated with caution against the development of septic shock.
authors.affiliation: Department of Urology, Kyorin University School of Medicine, 6-20-2, Shikawa, Mitaka, Tokyo, 181-8611, Japan, tanbodes@ks.kyorin-u.ac.jp.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Tambo
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Okegawa
authors.forename: Toshihide
authors.initials: T
authors.lastname: Shishido
authors.forename: Eiji
authors.initials: E
authors.lastname: Higashihara
authors.forename: Kikuo
authors.initials: K
authors.lastname: Nutahara
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011704:Pyelonephritis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014545:Urinary Calculi / Q000150:complications* / Q000175:diagnosis; D013520:Urologic Surgical Procedures / Q000379:methods*
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