Mortality predictive factors in patients with urinary sepsis associated to upper urinary tract calculi

• Published in: Medicina intensiva Vol. 39; no. 5; p. 290
• Main Authors: Badia, M, Iglesias, S, Serviá, L, Domingo, J, Gormaz, P, Vilanova, J, Gavilan, R, Trujillano, J
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.06.2015
• Subjects: Acute Disease; Acute Kidney Injury - etiology; Age Factors; Aged; Comorbidity; Dopamine - therapeutic use; Female; Gram-Negative Bacterial Infections - etiology; Gram-Negative Bacterial Infections - mortality; Hospital Mortality; Humans; Hydronephrosis - etiology; Intensive Care Units - statistics & numerical data; Male; Middle Aged; Norepinephrine - therapeutic use; Pyelonephritis - etiology; Pyelonephritis - microbiology; Pyelonephritis - mortality; Retrospective Studies; Risk Factors; Shock, Septic - etiology; Shock, Septic - mortality; Spain - epidemiology; Ureteral Calculi - complications; Ureteral Obstruction - complications; Factores de riesgo; Urinary tract calculi; Litiasis ureteral; Sepsis urológica; Urinary sepsis; Risk factors
• ISSN: 1578-6749
• DOI: 10.1016/j.medin.2014.07.003

The aims of this study were to determine the clinical characteristics of patients with urinary sepsis associated to ureteral calculi admitted to the Intensive Care Unit (ICU), and to identify predictors of mortality in the first 24 hours of admission. A retrospective observational study covering a 16-year period (2006-2011) was carried out. The combined clinical/surgical ICU of a secondary-level University hospital. All patients admitted to the ICU due to obstructive urinary sepsis. None. We analyzed general clinical and laboratory test and urological data. The diagnostic technique, affected side, decompression technique, isolated microorganism and antibiotic therapy used were also considered. The assessment of risk factors was performed by multiple logistic regression analysis. A total of 107 patients admitted to the ICU were included in the study, with a mortality rate of 19.6%. The diagnosis was mainly established by ultrasound, and the most commonly used decompression technique was retrograde JJ stenting. Microorganisms were isolated in 48.6% of the patients. In total, 20.6% of the patients had bacteremia. Multivariate analysis found age, acute renal failure and the use of vasoactive drugs administered continuously for the first 24 hours of admission to be independently associated to mortality. Advanced age, acute renal failure and the need for vasoactive drugs were associated to an increased risk of mortality in patients with urinary sepsis associated to upper urinary tract calculi.