title: Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection.
abstract: OBJECTIVE
  Urinary tract infection (UTI) is a common cause of severe sepsis, and anatomic urologic obstruction is a recognized factor for complicated disease. We aimed to identify the incidence of urinary obstruction complicating acute septic shock and determine the characteristics and outcomes of this group.
  
  
  METHODS
  Patients prospectively enrolled in a sepsis treatment pathway registry between October 2013 and July 2014 were reviewed for the diagnosis of UTI. Standardized medical record review was performed to confirm sepsis due to UTI and determine clinical variables including the presence of anatomic urinary obstruction. Patients with septic shock due to UTI with obstruction were compared with those without obstruction. The primary outcomes were incidence of urinary obstruction and hospital mortality.
  
  
  RESULTS
  Among 1084 registry enrollees, 209 (19.2%) met inclusion criteria for the study. Acute anatomic obstruction was identified in 22 (10.5%) patients. Hospital mortality in patients with obstruction was 27.3% compared with 11.2% in patients without obstruction (absolute difference of 16.1%; P = .03; 95% confidence interval [CI], 1.2%-30.9%). Hospital length of stay among survivors was 12.8 days compared with 8.3 days (absolute difference of 4.5 days; P = .04; 95% CI, 0.2-8.8 days). History of urinary stone disease was independently associated with obstruction (odds ratio, 5.6; 95% CI, 2.2-14.3).
  
  
  CONCLUSIONS
  Approximately 1 in 10 patients presenting with septic shock due to a urinary source is complicated by anatomic urinary obstruction. These patients have significantly higher mortality compared with patients without obstruction. Early imaging of patients with septic shock due to suspected urinary source should be considered to identify obstruction requiring emergency intervention.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC; Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX.
authors.forename: Karina
authors.initials: K
authors.lastname: Reyner
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC; Department of Internal Medicine, Division of Critical Care, Carolinas Medical Center, Charlotte, NC. Electronic address: acheffner@aol.com.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Heffner
authors.affiliation: Dickson Advanced Analytics, Carolinas Healthcare System, Charlotte, NC.
authors.forename: Colleen H
authors.initials: CH
authors.lastname: Karvetski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017052:Hospital Mortality; D006801:Humans; D007669:Kidney Calculi / Q000150:complications; D007902:Length of Stay; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000209:etiology* / Q000401:mortality; D014514:Ureteral Calculi / Q000150:complications; D014517:Ureteral Obstruction / Q000150:complications; D001748:Urinary Bladder Neck Obstruction / Q000150:complications; D014552:Urinary Tract Infections / Q000150:complications*; D014570:Urologic Diseases / Q000150:complications*