EAU 2018: Risk Factors Associated With Developing Septic Shock Among Patients With An Infected Obstructed Upper Urinary Tract

Copenhagen, Denmark (UroToday.com) Obstructed upper urinary tract (UUT) infections are emergent situations that should be treated immediately, as these patients are at a high risk for developing septic shock. Previous reports have assessed the rates of septic shock to be as high as one third of patients with an obstruction in the UUT. However, risk factors associated with increased odds of septic shock have not been widely assessed in large patient populations and would be highly beneficial in the efforts to improve patient outcome management.

Dr. S Tzemah (MD) from Haamel Medical Center Department of Urology in Afula, Israel, presented a retrospective review of 107 patients with an infected and obstructed UUT at a single institution. More specifically, the aim of the study was to identify clinical, laboratory, or radiographic characteristics that increased risk of septic shock during initial presentation.

Covariates were identified via uni- and multi-variate analysis and regression modeling. In paired t-tests, patient-related co-variates such as age, diabetes comorbidity, and Charlson Comorbidity Index were significantly correlated with the development of septic shocks. Additionally, patients presenting with symptoms of chills and systemic inflammatory response symptoms (SIRS) were also more likely to develop septic shock. Lastly, among both laboratory and imaging tests, only hemoglobin, creatinine, and positive blood culture were initially associated with the development of septic shock.

Of the 107 patients included in this cohort analysis, 17 (16%) patients developed septic shock after initial presentation. Once the abovementioned factors were included in multivariable analysis, however, only elevated creatinine levels and positive blood cultures were significantly associated with septic shock development (p<0.05). Of note, imaging results were neither correlated with septic shock in univariate analysis or in multivariate analysis.

In discussion, Dr. Patterson (session chair) critiques the association of elevated creatinine levels and septic shock and asserts that the former may be a consequence of the latter. However, Dr. Tzemah mentions that a diagnosis of septic shock was not confirmed until after inpatient admittance into the hospital (>12 hours after initial presentation in the emergency room). Even after initial treatment, a higher baseline level of creatinine was significantly associated with septic shock development within the first 24 hours and, therefore, confirms that elevated creatinine is a predictor and risk factor (rather than a confounder). While future studies are recommended to confirm these findings, the identification of possible risk factors and predictors for this life-threatening issue is an important pursuit for early intervention and prevention.

Presenter: S Tzemah

Authors: Lavi A., Tzemah S., Hussein A., Bishara I., Sherbecahkov N., Mashiah A., Zelichenko G., Gross M., Cohen M

Written by: Linda M. Huynh, B.S, University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark

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