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

Kozyrakis, Diomidis; Kratiras, Z.; Soukias, Georgios; Chatzistamou, Styliani-Elissavet; Zarkadas, Anastasios; Perikleous, Stefanos; Kateris, Dimitris; Katsaros, Ilias; Skriapas, Konstantinos; Karagiannis, Dimitrios

doi:10.1089/end.2019.0801

Cited by 14 publications

(11 citation statements)

References 26 publications

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“…Multivariate analysis revealed no difference in risk of urosepsis or septic shock postdecompression of ureteral obstruction or mortality rate. This corroborates well with existing studies 7,9,10 …”

Section: Discussionsupporting

confidence: 94%

“…This corroborates well with existing studies. 7,9,10 Although some studies demonstrate no differences in time taken for normalization of TWC and Creatinine, [10][11][12] our study reflected worse outcomes for PCN patients. The majority of our PCN patients underwent antegrade stenting post-PCN, which could have resulted in a delay in TWC and creatinine normalization due to further manipulation of the urinary system.…”

Section: Discussionmentioning

confidence: 53%

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Choosing the best way for urinary decompression and developing a novel predictive model for septic shock using SOFA in these patients

et al. 2022

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Objectives: To identify predictive factors for the development of sepsis/septic shock postdecompression of calculi-related ureteric obstruction using the Sequential Organ Failure Assessment (SOFA) score and to compare clinical outcomes and odd risk ratios of patients developing sepsis/septic shock following the insertion of percutaneous nephrostomy (PCN) versus insertion of retrograde ureteral stenting (RUS). Methods: Clinico-epidemiological data of patients who underwent PCN and/or RUS in two institutions for calculi-related ureteric obstruction were retrospectively collected from January 2014 to December 2020. Results: 537 patients (244 patients in PCN group, 293 patients in RUS group) from both institutions were eligible for analysis based on inclusion and exclusion criteria. Patients with PCN were generally older, had poorer Eastern Cooperative Oncology Group status, and larger obstructive ureteral calculi compared to patients with RUS. Patients with PCN had longer durations of fever, the persistence of elevated total white cell and creatinine, and longer hospitalization stays compared with patients who had undergone RUS. RUS up-front has more unsuccessful interventions compared with PCN. There were no significant differences in the change in SOFA score postintervention between the two interventions. In multivariate analysis, the higher temperature just prior to the intervention (adjusted odds ratio [OR]: 2.039, p = 0.003) and Cardiovascular SOFA score of 1 (adjusted OR:4.037, p = 0.012) were significant independent prognostic factors for the development of septic shock postdecompression of ureteral obstruction. Conclusions: Our study reveals that both interventions have similar overall risk of urosepsis, septic shock and mortality rate. Despite a marginally higher risk of failure, RUS should be considered in patients with lower procedural risk. Patients going for PCN should be counseled for a longer stay. Post-HDU/-ICU monitoring, inotrope support postdecompression should be considered for patients with elevated temperature within 1 h preintervention and cardiovascular SOFA score of 1.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 53%

Choosing the best way for urinary decompression and developing a novel predictive model for septic shock using SOFA in these patients

et al. 2022

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“…Notably, these three variables are generally included in routine investigations. The present study included most of the factors that were identi ed to be signi cant in the relevant previous studies [1][2][3][4][5][6][7][8][9][10][20][21][22][23][24][25]. However, we excluded lactate and ABGA levels from the analysis as they were already included in the Sepsis-3 diagnostic criteria [19].…”

Section: Discussionmentioning

confidence: 99%

“…Notably, DM and CRP were determined as the most important predictors of septic shock byYamamichi et al [6]. A prospective study by Kozyrakis et al[23] involved 62 patients with OAPN-US, of whom, 20 had sepsis and 6 had septic shock. Their results indicated a higher age, the existence of multiresistant strains, and a higher creatinine level as risk factors for sepsis.…”

mentioning

confidence: 99%

Machine learning-based prediction of septic shock in patients with obstructive pyelonephritis caused by ureteral stones

Min

Chung

et al. 2023

Preprint

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Obstructive acute pyelonephritis (OAPN) is a common condition that can rapidly become life-threatening. In particular, OAPN associated with ureteral stones (OAPN-US) should be treated by a diversion of the urinary tract. Notably, we focused on predicting septic shock, which can be highly fatal. Previous studies have suggested multiple variables for predicting septic shock, but most studies used the Sepsis-2 criteria, which were revised to the Sepsis-3 criteria in 2016. Furthermore, no studies have identified a confirmatory variable or proposed combination of multiple variables for the prediction of septic shock. This study aimed to determine the best combination of potential predictors of septic shock in patients with OAPN-US based on the Sepsis-3 criteria. Our approach was based on machine learning (ML) because previous studies have demonstrated high performance of ML and because it can easily identify the combined effects of multiple variables. We selected three variables from approximately 30 factors and compared five ML algorithms. Notably, the random forest algorithm demonstrated the best performance, with an area under the receiver operating curve of 0.9965 and accuracy of 0.9583. Among the selected factors, procalcitonin had the highest Gini importance score. To the best of our knowledge, this is the first study to use ML for the predication of septic shock. Excellent predictions were made after identifying the optimal combination of multiple predictors.

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“…Septic shock is the most common critical illness in intensive care unit (ICU), with long hospital stay, high cost, and high mortality ( 1 – 3 ). Intestinal perforation is one of the important causes of septic shock ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Association Between Different DVT Prevention Methods and Outcomes of Septic Shock Caused by Intestinal Perforation in China: A Cross-Sectional Study

Wang

Ma²,

et al. 2022

Front. Med.

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IntroductionSeptic shock, largely caused by intestinal perforation, is the most common critical illness in intensive care unit (ICU). As an important quality control strategy in ICU, deep vein thrombosis (DVT) prevention is routinely used in the treatment of septic shock. Nevertheless, the effects of DVT prevention on septic shock are not fully revealed. This study was thus designed to investigate the effects of DVT prevention on septic shock caused by intestinal perforation in China.MethodsA total of 463 hospitals were enrolled in a survey, led by the China National Critical Care Quality Control Center (China NCCQC) from January 1, 2018 to December 31, 2018. The association between DVT prevention, including pharmacological prophylaxis and mechanical prophylaxis, and outcomes, such as prognosis, complications, hospital stays, and hospitalization costs, was determined in the present study.Main ResultsNotably, the increased rates of DVT prevention were not associated with the onset of complications in patients with septic shock caused by intestinal perforation (p > 0.05). In addition, even though increased DVT prevention did not affect hospital stays, it significantly decreased the discharge rates without doctor's order in patients with septic shock caused by intestinal perforation (p < 0.05). Nevertheless, it should be noted that the rates of pharmacological prophylaxis but not mechanical prophylaxis were significantly associated with the costs of septic shock caused by intestinal perforation (p < 0.05). Although increased total rates of DVT prevention and the rates of mechanical prophylaxis did not reduce the mortality in patients with septic shock caused by intestinal perforation, the higher frequent intervention using pharmacological prophylaxis indicated the lower mortality of these patients (p < 0.05).ConclusionsDVT prevention by any means is a safe therapeutic strategy for treating septic shock caused by intestinal perforation, and pharmacological prophylaxis reduced the mortality of patients with septic shock caused by intestinal perforation.

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

Cited by 14 publications

References 26 publications

Choosing the best way for urinary decompression and developing a novel predictive model for septic shock using SOFA in these patients

Choosing the best way for urinary decompression and developing a novel predictive model for septic shock using SOFA in these patients

Machine learning-based prediction of septic shock in patients with obstructive pyelonephritis caused by ureteral stones

Association Between Different DVT Prevention Methods and Outcomes of Septic Shock Caused by Intestinal Perforation in China: A Cross-Sectional Study

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