Clinical and computed tomography factors associated with sepsis in women with clinically uncomplicated pyelonephritis
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KIDNEYS, URETERS, BLADDER, RETROPERITONEUM
Clinical and computed tomography factors associated with sepsis in women with clinically uncomplicated pyelonephritis Young Rock Jang1 · Su Joa Ahn2 · Seung Joon Choi2 · Joong Sik Eom1 · Yong Kyun Cho1 · Young Sup Shim2 · So Hyun Park2 · Jeong Ho Kim2 · Hyung‑Sik Kim2 Received: 29 April 2020 / Revised: 28 July 2020 / Accepted: 18 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective Sepsis is major determinants of prognosis in acute pyelonephritis (APN). This study aimed to assess factors associated with the development of sepsis among patients with clinically uncomplicated APN. Subjects and methods We examined 463 patients presenting to our hospital without complications. We assessed clinical factors including demographic and laboratory features. Renal and extrarenal features on computed tomography (CT) were also analyzed. Risk factors of sepsis are assessed. Results The study included 361 patients without (78.0%) and 102 patients with sepsis (22.0%). Crude and attributable mortality rates were 3.9% and 2.0% versus 1.4% and 0.6%, respectively, among patients with and without sepsis. Clinical risk factors for sepsis were age >65 years (odds ratio [OR] 1.79, P = 0.02), absence of flank pain (OR 1.59, P = 0.04), absence of costovertebral tenderness (OR 1.89, P = 0.03), diabetes mellitus (OR 2.25, P = 0.02), bacteremia (OR 2.8, P = 0.01), C-reactive protein level >100 mg/L (OR 1.42, P = 0.02), and lack of previous APN history (OR 1.76, P = 0.04). APN grade IV (OR 3.16, P = 0.01), high grade hydronephrosis (OR 1.50, P = 0.03), diffuse peritoneal thickening (OR 4.12, P = 0.01), and acute interstitial pulmonary edema (OR 3.73, P = 0.01) were the CT features predictive of septic shock. Conclusions Although uncomplicated APN was largely non-fatal, several clinical and CT features could lead to sepsis. Our findings may be useful for predicting sepsis risk and deciding whether intravenous antibiotic treatment and intensive management should be initiated for uncomplicated APN. Keywords Pyelonephritis · Sepsis · Computed tomography
Introduction Acute pyelonephritis (APN) is a very common reason for visits to the emergency department and leads to a significant number of hospital admissions. It has a high incidence (9–11 cases per 10,000 population) [1]. The clinical features of APN vary greatly, from mild costovertebral tenderness and fever to a life-threatening condition or even death [2, 3]. Although complicated APN can progress to urosepsis and * Su Joa Ahn [email protected] 1
Division of Infectious Disease, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 24, Namdong‑daero 774beon‑gil, Namdong‑gu, Incheon, Republic of Korea
2
cause severe conditions, including septic shock and disseminated intravascular coagulopathy (DIC) [4], uncomplicated APN usually has good prog
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