What Are the Predictive Factors of Severe Conditions in Acute Obstructive Pyelonephritis?

Jun Kamei; Yukio Homma

doi:10.14777/uti.2016.11.1.12

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Kamei and Homma: What Are the Predictive Factors of Severe Conditions in Acute Obstructive Pyelonephritis?

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Urogenit Tract Infect 2016;11(1):12-16.

Published online: 20 April 2016

DOI: https://doi.org/10.14777/uti.2016.11.1.12

What Are the Predictive Factors of Severe Conditions in Acute Obstructive Pyelonephritis?

Jun Kamei, Yukio Homma

Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan

Correspondence to: Jun Kamei http://orcid.org/0000-0002-0069-7392 Department of Urology, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan Tel: +81-3-5800-3815-5411, Fax: +81-3-5800-8917 E-mail: jkamei-tky@umin.ac.jp

Received 6 March 2016 Revised 5 April 2016 Accepted 8 April 2016

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

Acute obstructive pyelonephritis is a common urological infection, often requiring emergency drainage, which shows rapid progression to serious conditions, including severe sepsis or septic shock. Therefore, during an initial evaluation, knowledge of factors for prediction of severe conditions or mortality is important for immediate identification of patients requiring intensive care. Previous studies examining the characteristics of patients with acute obstructive or calculous pyelonephritis reported rates of septic shock and mortality of 20.8–33.3% and 0–7.4%, respectively. Thrombocytopenia, older age, low serum albumin, and bacteremia were relatively common predictors for septic shock. In contrast, age over 80 years, systemic inflammatory response syndrome, disseminated intravascular coagulation status, disturbance of consciousness, male gender, and having only one kidney were predictive factors for mortality.

Keywords: Pyelonephritis, Sepsis, Septic shock, Ureteral calculi, Ureteral obstruction

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Table 1.

Predictive factors for severe conditions and mortality in patients with obstructive pyelonephritis

Author, year	Number	Study patients	Diagnostic criteria	Definition of severe condition	Rate of		Risk factors for
Author, year	Number	Study patients	Diagnostic criteria	Definition of severe condition	Severe condition	Mortality	Severe condition	Mortality
Lim et al., 2015 [6]	73	Calculus pyelonephritis	SIRS	Sepsis	50.7	NE	Age, albumin, NLR	NE
Tambo et al., 2014 [7]	69	Calculus pyelonephritis	Fever, pyuria	Shock	33.3	0	Thrombocytopenia, albumin	NE
Yamamoto et al., 2012 [8]	101	Calculus pyelonephritis required drainage	Fever, inflammation	Shock	20.8	2.0	Age, paralysis	NE
Angulo et al., 2010 [9]	110	Calculus pyelonephritis	SIRS	Drainage	26.4	0	CRR age	NE
Yoshimura et al., 2005 [10]	473	Calculus pyelonephritis	SIRS	Drainage	12.5	0.2	Age, female gender, poor PS	NE
Kamei et al., 2014 [11]	54	Obstructive pyelonephritis required drainage	SIRS	Shock	37.0	1.8	Thrombocytopenia, bacteremia	NE
Chung et al., 2014 [12]	68	Severe acute pyelonephritis	Mortality or ICU or intervention	Long hospital stay (>14 days)	32.4	7.4	Bacteremia, shock, ICU, suppurative pyelonephritis	Male gender, DIC
Hamasuna et al., 2015 [13]	1,363	Calculus pyelonephritis	Diagnosed by urologists	Undefined	NE	2.3	NE	Age, SIRS, DIC, single kidney, DOC

SIRS: systemic inflammatory response syndrome, NE: not evaluated, NLR: neutrophil to lymphocyte ratio, CRP: C-reactive protein, PS: performance status, ICU: intensive care unit, DIC: disseminated intravascular coagulation, DOC: disturbance of consciousness.

Table 2.

Predictive factors for emergency drainage, septic shock, and mortality

Predictive factors for emergency drainage

C-reactive protein

Female gender

Older age

Poor performance status

Predictive factors for septic shock

Bacteremia

Low serum albumin

Neutrophil to lymphocyte ratio

Paralysis

Thrombocytopenia

Predictive factors for mortality

Age over 80 years

Disseminated intravascular coagulation

Disturbance of consciousness

Male gender

Systemic inflammatory response syndrome

Solitary kidney

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