Journal List > Urogenit Tract Infect > v.11(1) > 1084195

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

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.

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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
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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