title: Procalcitonin determined at emergency department as na early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi.
abstract: BACKGROUND
  To investigate the role of initial procalcitonin (PCT) level as an early predictor of septic shock for the patient with sepsis induced by acute pyelonephritis (APN) secondary to ureteral calculi.
  
  
  METHODS
  The data from 49 consecutive patients who met criteria of sepsis due to APN following ureteral stone were collected and divided into two groups: with (n=15) or without (n=34) septic shock. The clinical variables including PCT level for this outcome were retrospectively compared by univariate analysis, followed by multivariable logistic regression model.
  
  
  RESULTS
  All subjects had hydronephrosis, and were hospitalized with the mean of 11.8 days (3-42 days). The mean size of the ureteral stones was 7.5mm (3-30mm), and 57% were located in upper ureter. At univariate analysis, patients with septic shock were significantly older, a higher proportion had hypertension, lower platelet count and serum albumin level, higher CRP and PCT level, and higher positive blood culture rate. Multivariate models indicated that lower platelet count and higher PCT level are independent risk factors (p=0.043 and 0.046, respectively). In ROC curve, the AUC was significantly wider in PCT (0.929), compared with the platelet count (0.822, p=0.004). At the cut-off of 0.52ng/mL, the sensitivity and specificity were 86.7% and 85.3%.
  
  
  CONCLUSIONS
  Our study demonstrated elevated initial PCT levels as an early independente predictor to progress into septic shock in patients with sepsis associated with ureteral calculi.
authors.affiliation: Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea.
authors.forename: Young Hwii
authors.initials: YH
authors.lastname: Ko
authors.affiliation: Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea.
authors.forename: Yoon Seob
authors.initials: YS
authors.lastname: Ji
authors.affiliation: Department of Emergency medicine, College of Medicine, Yeungnam University, Daegu, Korea.
authors.forename: Sin-Youl
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Emergency medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea.
authors.forename: Phil Hyun
authors.initials: PH
authors.lastname: Song
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011704:Pyelonephritis / Q000097:blood* / Q000209:etiology; D012372:ROC Curve; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D012772:Shock, Septic / Q000097:blood* / Q000209:etiology; D018709:Statistics, Nonparametric; D014514:Ureteral Calculi / Q000097:blood* / Q000150:complications; D055815:Young Adult
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D002116:Calcitonin; D002097:C-Reactive Protein