J Korean Soc Emerg Med.  2020 Jun;31(3):267-274.

A single emergency center study for obstructive urinary tract infection with sepsis

Affiliations
  • 1Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, Gumi, Korea
  • 2Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
  • 3Department of Emergency Medicine, Daegu Catholic University School of Medicine, Daegu, Korea

Abstract


Objective
Unlike common acute urinary tract infections, obstructive urinary tract infections caused by urinary calculus can be fatal because they can progress to sepsis and cause shock or disseminated intravascular coagulation. The evidence of patients with obstructive urinary tract infections caused by urinary tract stones visiting the emergency center is still lacking.
Methods
Seventy-seven patients who visited the emergency room with obstructive urinary tract infections caused by urinary calculus from January 2016 to December 2018 were enrolled in this study and divided into two groups: sepsis group and non-sepsis group.
Results
The lymphocyte count, platelet count, neutrophil-lymphocyte ratio, serum creatinine, and C-reactive protein were significantly different in the sepsis-positive and negative groups. Percutaneous nephrostomy was also significantly higher in the sepsis-positive group. The area under the receiver operating characteristic curve was calculated to evaluate the ability of the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio to predict a septic urinary tract infection. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were 0.659 and 0.550, respectively. Multivariate logistic regression analysis showed that diabetic patients, percutaneous nephrostomy, and serum creatinine were associated with septic obstructive urinary tract infection.
Conclusion
In patients with an obstructive urinary tract infection who were referred to the emergency center, diabetic patients and those with high blood urea nitrogen and creatinine levels are at high risk of sepsis. In such cases, rapid diagnosis and treatment, such as percutaneous nephrostomy, are necessary.

Keyword

Sepsis; Urinary tract infections; Urinary calculi
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