Risk Factors of Sepsis in Obstructive Acute Pyelonephritis Associated with Urinary Tract Calculi

Chae Hong Lim; Jae Seung Hwang; Dae Ji Kim; Seok Heun Jang; Jeong Hwan Son; Dae Sung Cho; Jae Won Lee

doi:10.14777/uti.2015.10.02.108

Journal List > Urogenit Tract Infect > v.10(2) > 1084181

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Lim, Hwang, Kim, Jang, Son, Cho, and Lee: Risk Factors of Sepsis in Obstructive Acute Pyelonephritis Associated with Urinary Tract Calculi

Original Article

Urogenit Tract Infect 2015;10(2):108-111.

Published online: 19 October 2015

DOI: https://doi.org/10.14777/uti.2015.10.02.108

Risk Factors of Sepsis in Obstructive Acute Pyelonephritis Associated with Urinary Tract Calculi

Chae Hong Lim, Jae Seung Hwang, Dae Ji Kim, Seok Heun Jang, Jeong Hwan Son, Dae Sung Cho, Jae Won Lee

Department of Urology, Bundang Jesaeng General Hospital, Seongnam, Korea

Correspondence to: Jae Won Lee http://orcid.org/0000-0002-1844-3673 Department of Urology, Bundang Jesaeng General Hospital, 20 Seohyeon-ro 180 beon-gil, Bundang-gu, Seongnam 13590, Korea Tel: +82-31-779-0165, Fax: +82-31-779-0169 E-mail: urojwlee@dmc.or.kr

Received 22 August 2015 Revised 23 September 2015 Accepted 2 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The aim of this study is to identify the risk factors for development of sepsis in patients with obstructive acute pyelonephritis (APN) associated with urinary tract calculi.

Materials and Methods:

Between January 2004 and December 2013, 73 patients with obstructive APN associated with upper urinary tract calculi were admitted to our institution. Medical records of 73 patients (14 men and 59 women, mean age of 57 years) were reviewed retrospectively. The risk factors for sepsis were analyzed using multivariate logistic regression analysis.

Results:

Of 73 patients, 37 (50.7%) developed sepsis. Old age and history of hypertension were more common in the sepsis group than in the non-sepsis group (p＜0.001 and p=0.018). The white blood cell count, neutrophil count, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein level were significantly higher in the sepsis group (p=0.011, p=0.001, p=0.042, p＜0.001 and p=0.006, respectively). Lymphocyte count, platelet count, and albumin level were significantly lower in the sepsis group (p＜0.001, p=0.008 and p＜0.001, respectively). Multivariate logistic regression analysis indicated that old age (odds ratio [OR], 2.13; p=0.023), decrease in serum albumin level (OR, 4.27; p=0.041), and high NLR (OR, 3.83; p=0.037) were independent risk factors for development of sepsis.

Conclusions:

Elderly patients with obstructive APN associated with urinary tract calculi who have low serum albumin levels and high NLR should be treated carefully against development of sepsis.

Keywords: Pyelonephritis, Sepsis, Calculi

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Table 1.

A comparison of the clinical characteristics of patients with and without sepsis

Characteristic	Sepsis		p-value
Characteristic	Yes	No	p-value
Patients	37 (50.7)	36 (49.3)
Age (y)	64±13	49±13	＜0.001
Gender			0.515
Male	8 (22.2)	6 (16.2)
Female	28 (77.8)	31 (83.8)
Laterality			0.549
Right	15 (41.7)	18 (48.6)
Left	21 (58.3)	19 (51.4)
Hypertension			0.018
Negative	26 (72.2)	16 (43.2)
Positive	10 (27.8)	21 (56.8)
Diabetes mellitus			0.258
Negative	31 (86.1)	28 (75.7)
Positive	5 (13.9)	9 (24.3)
Performance status			0.698
0-1	30 (83.3)	17 (45.9)
2-4	6 (16.7)	20 (54.1)
White blood cell count (×10³/l)	11.8±3.9	14.5±5.0	0.011
Lymphocyte count (×10³/l)	1.6±0.8	0.9±0.5	＜0.001
Neutrophil count (×10³/l) ⁵	9.3±4.3	12.9±4.7	0.001
Platelet count (×10⁵/l)	2.3±0.6	1.8±0.9	0.008
Platelet to lymphocyte ratio	173.8±71.3	244.2±191.3	0.042
Neutrophil to lymphocyte ratio	8.0±6.5	18.5±13.3	＜0.001
C-reactive protein (mg/dl)	7.2±6.3	11.5±6.5	0.006
Serum albumin (g/dl)	3.9±0.4	3.4±0.6	＜0.001

Values are presented as number (%) or mean±standard deviation.

Table 2.

Multivariate logistic regression analysis of risk factors for sepsis

Variable	Occurrence of sepsis
Variable	Odds ratio	95% confidence interval	p-value
Old age (≤60 vs. >60 y)	2.13	1.88-4.79	0.023
Serum albumin (>3.5 vs. ≤3.5 g/dl)	4.27	0.62-7.16	0.041
Neutrophil to lymphocyte ratio (≤10:1 vs. >10:1)	3.83	0.75-5.14	0.037

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