title: A NOVEL SCORING SYSTEM: PREDICTING SEPTIC SHOCK AT DIAGNOSIS EASILY IN ACUTE COMPLICATED PYELONEPHRITIS PATIENTS.
abstract: (Objectives) Because acute complicated pyelonephritis can easily cause sepsis and concomitant shock status, it is a potentially lethal disease. However, the predictors for the severity of pyelonephritis is not well analyzed. In this study, we aimed at clarifying the clinical characteristic risk factors associated with septic shock in patients with acute complicated pyelonephritis. (Materials and methods) From May 2009 to March 2014, 267 patients with acute complicated pyelonephritis were treated at our institution. We investigated the characteristics of the patients associated with septic shock, and assessed risk factors in these patients. By using these risk factors, we established a novel scoring system to predict septic shock. (Results) 267 patients included 145 patients with ureteral calculi and 75 patients with stent-related pyelonephritis. Septic shock occurred in 35 patients (13%), and the mortality rate was 0.75%. Multivariate analysis revealed that (P): Performance Status ≥3 (p=0.0014), (U): Presence of Ureteral calculi (p=0.043), (S): Sex of female (p=0.023), and (H): the presence of Hydronephrosis (p=0.039) were independent risk factors for septic shock. P.U.S.H. scoring system (range 0-4), which consists of these 4 factors, were positively correlated with the rate of septic shock (score 0: 0%, 1: 5.3%, 2: 3.4%, 3: 25.0%, 4: 42.3%). Importantly, patients with 3-4 P.U.S.H. scores were statistically more likely to become septic shock than those with 0-2 score (p=0.00014). (Conclusions) These results suggest that P.U.S.H. scoring system using 4 clinical factors is useful to predict the status of septic shock in patients with acute complicated pyelonephritis.
authors.affiliation: The Department of Urology, Ijinkai Takeda General Hospital.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kubota
authors.forename: Toru
authors.initials: T
authors.lastname: Kanno
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Nishiyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Okada
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Higashi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamada
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D006869:Hydronephrosis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011704:Pyelonephritis / Q000150:complications* / Q000175:diagnosis*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012772:Shock, Septic / Q000175:diagnosis* / Q000209:etiology*; D014514:Ureteral Calculi