Relevance of clinical and serum parameters on severe urinary sepsis after renal obstruction.

• Published in: Archivos españoles de urología Vol. 73; no. 4; p. 257
• Main Authors: Bedate-Núñez, María, Moreno-Racionero, Francisca, de Andrés-Asenjo, Beatriz, Díaz-Romero, Juan Manuel, Soto-Rodríguez, José Luis, Torrecilla-García-Ripoll, Juan Ramón, Martín-Martín, Sergio, Rivero-Martínez, María Dolores, Calleja-Escudero, Jesús, De Castro-Olmedo, Carlos, Pascual-Samaniego, Miguel, Calvo-González, Raúl, Valsero-Herguedas, María Esther, Pesquera-Ortega, Laura, Lara-Pérez, Francisco María, Ruano-Mayo, Ana, Zamora-Horcajadas, Álvaro, Natal-Álvarez, Fernando, Legido Morán, Ana Patricia, Rabadán-Jiménez, José Máximo, Cortiñas-González, José Ramón, Bermejo-Martín, Jesús Francisco
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.05.2020
• Subjects: Biomarkers; Humans; Prognosis; Prospective Studies; ROC Curve; Sepsis; Shock, Septic; Urinary Tract Infections; Sepsis grave; High septic obstructive uropathy; Uropatía obstructiva alta séptica; Sepsis biomarker; Severe sepsis; Biomarcador sepsis
• ISSN: 0004-0614

Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC:0.919). SS risk factors (p<0.005) were the history of cancer immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. There is an analytical profile maintained over the time characteristic of SS that allows anearly identification of patients with OU subsidiary of been complicated with SS.