title: Risk Factors for Development of Septic Shock in Patients with Urinary Tract Infection.
abstract: BACKGROUND
  Severe sepsis and septic shock are associated with substantial mortality. However, few studies have assessed the risk of septic shock among patients who suffered from urinary tract infection (UTI).
  
  
  METHODS
  This retrospective study recruited UTI cases from an acute care hospital between January 2006 and October 2012 with prospective data collection.
  
  
  RESULTS
  Of the 710 participants admitted for UTI, 80 patients (11.3%) had septic shock. The rate of bacteremia is 27.9%; acute kidney injury is 12.7%, and the mortality rate is 0.28%. Multivariable logistic regression analyses indicated that coronary artery disease (CAD) (OR: 2.521, 95% CI: 1.129-5.628, P = 0.024), congestive heart failure (CHF) (OR: 4.638, 95% CI: 1.908-11.273, P = 0.001), and acute kidney injury (AKI) (OR: 2.992, 95% CI: 1.610-5.561, P = 0.001) were independently associated with septic shock in patients admitted with UTI. In addition, congestive heart failure (female, OR: 4.076, 95% CI: 1.355-12.262, P = 0.012; male, OR: 5.676, 95% CI: 1.103-29.220, P = 0.038, resp.) and AKI (female, OR: 2.995, 95% CI: 1.355-6.621, P = 0.007; male, OR: 3.359, 95% CI: 1.158-9.747, P = 0.026, resp.) were significantly associated with risk of septic shock in both gender groups.
  
  
  CONCLUSIONS
  This study showed that patients with a medical history of CAD or CHF have a higher risk of shock when admitted for UTI treatment. AKI, a complication of UTI, was also associated with septic shock. Therefore, prompt and aggressive management is recommended for those with higher risks to prevent subsequent treatment failure in UTI patients.
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan ; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Hsiao
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Huang-Yu
authors.initials: HY
authors.lastname: Yang
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chih-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Emergency, FooYin University Hospital, Pingtung County, Taiwan ; Department of Nurse, Tajen University, Pingtung, Taiwan.
authors.forename: Hsing-Lin
authors.initials: HL
authors.lastname: Lin
authors.affiliation: Division of Allergy, Asthma, and Rheumatology, Departmen of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chao-Yi
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Meng-Chang
authors.initials: MC
authors.lastname: Hsiao
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan ; Department of Applied Life Science and Health, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Peir-Haur
authors.initials: PH
authors.lastname: Hung
authors.affiliation: Department of Family Medicine, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Su-Hsun
authors.initials: SH
authors.lastname: Liu
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Weng
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Cheng-Chia
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Division of Chest, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan ; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Tzu-Chin
authors.initials: TC
authors.lastname: Wu
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology* / Q000473:pathology