Clinical Outcome and Prognostic Factors of Sepsis, Septic Shock and Prolonged Hospitalization, of Patients Presented with Acute Obstructive Pyelonephritis

Abstract

<b><i>Objective:</i></b> To investigate prognostic factors of outcome of acute obstructive pyelonephritis (AOP). <b><i>Materials and Methods:</i></b> Patients with AOP were prospectively evaluated and logistic regression analysis was applied to identify factors associated with the duration of hospital stay and occurrence of sepsis and septic shock. <b><i>Results:</i></b> Based on CT scan findings, 62 patients were found to have AOP and subjected to emergency drainage. The main etiology of obstruction was lithiasis (70.9%). Double-J stent and percutaneous nephrostomy were introduced in 48 and 14 patients, respectively. Urosepsis and septic shock were diagnosed in 20 (32%) and 6 (9.7%) patients, respectively. None of the patients died of sepsis. In univariative analysis, older age, high neutrophils, increased serum creatinine, higher Charlson comorbidity index (CCI) score, any CCI score ≥1, diabetes mellitus (DM) longer operation time (OT), and multiresistant stains were risk factors of sepsis. Gender, type of drainage, laterality, white blood cell count, neutrophils rate >80%, C-reactive protein, and the presence of malignancy or lithiasis were not. Age, DM, and CCI score ≥1 were associated with prolonged hospitalization. None of the factors was associated with shock. In multivariative models, age (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.02-1.16, <i>p</i> = 0.010), multiresistant strains (OR: 16.36, 95% CI: 1.97-135.71, <i>p</i> = 0.006), OT >20 minutes (OR: 1.03, 95% CI: 1.00-1.07, <i>p</i> = 0.048), and elevated creatinine (OR: 1.68, 95% CI: 1.001-2.84, <i>p</i> = 0.049) were independent prognostic factors of sepsis, and DM (OR: 30.8%, CI: 8.86%-52.8%, <i>p</i> = 0.007) was a prognostic factor of longer hospitalization. <b><i>Conclusions:</i></b> One-third of AOP patients will develop sepsis. Older age, elevated serum creatinine, longer OT presence of multiresistant strains, and DM are independent factors of worse outcome.