Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection

• Published in: The American journal of emergency medicine Vol. 34; no. 4; pp. 694 - 696
• Main Authors: Reyner, Karina, MD, Heffner, Alan C., MD, Karvetski, Colleen H., PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Blood pressure; Classification; Confidence intervals; Data collection; Disease; Emergency; Emergency medical care; Hospital Mortality; Hospitalization; Hospitals; Humans; Infections; Kidney Calculi - complications; Kidneys; Length of Stay; Middle Aged; Mortality; Retrospective Studies; Sepsis; Shock, Septic - etiology; Shock, Septic - mortality; Studies; Ureteral Calculi - complications; Ureteral Obstruction - complications; Urinary Bladder Neck Obstruction - complications; Urinary Tract Infections - complications; Urogenital system; Urologic Diseases - complications; Variables
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.12.068

Abstract Objective Urinary tract infection (UTI) is a common cause of severe sepsis, and anatomic urologic obstruction is a recognized factor for complicated disease. We aimed to identify the incidence of urinary obstruction complicating acute septic shock and determine the characteristics and outcomes of this group. Methods Patients prospectively enrolled in a sepsis treatment pathway registry between October 2013 and July 2014 were reviewed for the diagnosis of UTI. Standardized medical record review was performed to confirm sepsis due to UTI and determine clinical variables including the presence of anatomic urinary obstruction. Patients with septic shock due to UTI with obstruction were compared with those without obstruction. The primary outcomes were incidence of urinary obstruction and hospital mortality. Results Among 1084 registry enrollees, 209 (19.2%) met inclusion criteria for the study. Acute anatomic obstruction was identified in 22 (10.5%) patients. Hospital mortality in patients with obstruction was 27.3% compared with 11.2% in patients without obstruction (absolute difference of 16.1%; P = .03; 95% confidence interval [CI], 1.2%-30.9%). Hospital length of stay among survivors was 12.8 days compared with 8.3 days (absolute difference of 4.5 days; P = .04; 95% CI, 0.2-8.8 days). History of urinary stone disease was independently associated with obstruction (odds ratio, 5.6; 95% CI, 2.2-14.3). Conclusions Approximately 1 in 10 patients presenting with septic shock due to a urinary source is complicated by anatomic urinary obstruction. These patients have significantly higher mortality compared with patients without obstruction. Early imaging of patients with septic shock due to suspected urinary source should be considered to identify obstruction requiring emergency intervention.