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Risk Factors for Development of Septic Shock in Patients with Urinary Tract Infection.

Hsiao CY, Yang HY, Chang CH, Lin HL, Wu CY, Hsiao MC, Hung PH, Liu SH, Weng CH, Lee CC, Yen TH, Chen YC, Wu TC - Biomed Res Int (2015)

Bottom Line: The rate of bacteremia is 27.9%; acute kidney injury is 12.7%, and the mortality rate is 0.28%.In addition, congestive heart failure (female, OR: 4.076, 95% CI: 1.355-12.262, P = 0.012; male, OR: 5.676, 95% CI: 1.103-29.220, P = 0.038, resp.) and AKI (female, OR: 2.995, 95% CI: 1.355-6.621, P = 0.007; male, OR: 3.359, 95% CI: 1.158-9.747, P = 0.026, resp.) were significantly associated with risk of septic shock in both gender groups.Therefore, prompt and aggressive management is recommended for those with higher risks to prevent subsequent treatment failure in UTI patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan ; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.

ABSTRACT

Introduction: Severe sepsis and septic shock are associated with substantial mortality. However, few studies have assessed the risk of septic shock among patients who suffered from urinary tract infection (UTI).

Materials and methods: This retrospective study recruited UTI cases from an acute care hospital between January 2006 and October 2012 with prospective data collection.

Results: Of the 710 participants admitted for UTI, 80 patients (11.3%) had septic shock. The rate of bacteremia is 27.9%; acute kidney injury is 12.7%, and the mortality rate is 0.28%. Multivariable logistic regression analyses indicated that coronary artery disease (CAD) (OR: 2.521, 95% CI: 1.129-5.628, P = 0.024), congestive heart failure (CHF) (OR: 4.638, 95% CI: 1.908-11.273, P = 0.001), and acute kidney injury (AKI) (OR: 2.992, 95% CI: 1.610-5.561, P = 0.001) were independently associated with septic shock in patients admitted with UTI. In addition, congestive heart failure (female, OR: 4.076, 95% CI: 1.355-12.262, P = 0.012; male, OR: 5.676, 95% CI: 1.103-29.220, P = 0.038, resp.) and AKI (female, OR: 2.995, 95% CI: 1.355-6.621, P = 0.007; male, OR: 3.359, 95% CI: 1.158-9.747, P = 0.026, resp.) were significantly associated with risk of septic shock in both gender groups.

Conclusion: This study showed that patients with a medical history of CAD or CHF have a higher risk of shock when admitted for UTI treatment. AKI, a complication of UTI, was also associated with septic shock. Therefore, prompt and aggressive management is recommended for those with higher risks to prevent subsequent treatment failure in UTI patients.

No MeSH data available.


Related in: MedlinePlus

Inclusion and exclusion criteria of our study subjects.
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Related In: Results  -  Collection


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fig1: Inclusion and exclusion criteria of our study subjects.

Mentions: From January 2006 to October 2012, we consecutively studied hospitalized patients with the diagnosis of UTI in Chiayi Christian Hospital. The criteria of UTI in this study are based on clinical symptoms and laboratory diagnosis, including pain on urination (dysuria), lumbago, or fever with bacterial isolation of more than 104 colony forming units (CFU)/mL [9]. Septic shock was defined as sepsis with hypotension (systolic blood pressure (SBP) < 90 mmHg or mean arterial pressure (MAP) < 70 mmHg or SBP decrease > 40 mmHg or less than two standard deviations below normal for age in the absence of other causes of hypotension) over one hour, despite adequate fluid resuscitation at time of admission or during hospitalization [10]. Asymptomatic cases, UTI concurrent with other infection, patients on dialysis therapy, and shocks other than septic shock were excluded, as shown in Figure 1. All data were prospectively collected with a standard form.


Risk Factors for Development of Septic Shock in Patients with Urinary Tract Infection.

Hsiao CY, Yang HY, Chang CH, Lin HL, Wu CY, Hsiao MC, Hung PH, Liu SH, Weng CH, Lee CC, Yen TH, Chen YC, Wu TC - Biomed Res Int (2015)

Inclusion and exclusion criteria of our study subjects.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4561874&req=5

fig1: Inclusion and exclusion criteria of our study subjects.
Mentions: From January 2006 to October 2012, we consecutively studied hospitalized patients with the diagnosis of UTI in Chiayi Christian Hospital. The criteria of UTI in this study are based on clinical symptoms and laboratory diagnosis, including pain on urination (dysuria), lumbago, or fever with bacterial isolation of more than 104 colony forming units (CFU)/mL [9]. Septic shock was defined as sepsis with hypotension (systolic blood pressure (SBP) < 90 mmHg or mean arterial pressure (MAP) < 70 mmHg or SBP decrease > 40 mmHg or less than two standard deviations below normal for age in the absence of other causes of hypotension) over one hour, despite adequate fluid resuscitation at time of admission or during hospitalization [10]. Asymptomatic cases, UTI concurrent with other infection, patients on dialysis therapy, and shocks other than septic shock were excluded, as shown in Figure 1. All data were prospectively collected with a standard form.

Bottom Line: The rate of bacteremia is 27.9%; acute kidney injury is 12.7%, and the mortality rate is 0.28%.In addition, congestive heart failure (female, OR: 4.076, 95% CI: 1.355-12.262, P = 0.012; male, OR: 5.676, 95% CI: 1.103-29.220, P = 0.038, resp.) and AKI (female, OR: 2.995, 95% CI: 1.355-6.621, P = 0.007; male, OR: 3.359, 95% CI: 1.158-9.747, P = 0.026, resp.) were significantly associated with risk of septic shock in both gender groups.Therefore, prompt and aggressive management is recommended for those with higher risks to prevent subsequent treatment failure in UTI patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan ; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.

ABSTRACT

Introduction: Severe sepsis and septic shock are associated with substantial mortality. However, few studies have assessed the risk of septic shock among patients who suffered from urinary tract infection (UTI).

Materials and methods: This retrospective study recruited UTI cases from an acute care hospital between January 2006 and October 2012 with prospective data collection.

Results: Of the 710 participants admitted for UTI, 80 patients (11.3%) had septic shock. The rate of bacteremia is 27.9%; acute kidney injury is 12.7%, and the mortality rate is 0.28%. Multivariable logistic regression analyses indicated that coronary artery disease (CAD) (OR: 2.521, 95% CI: 1.129-5.628, P = 0.024), congestive heart failure (CHF) (OR: 4.638, 95% CI: 1.908-11.273, P = 0.001), and acute kidney injury (AKI) (OR: 2.992, 95% CI: 1.610-5.561, P = 0.001) were independently associated with septic shock in patients admitted with UTI. In addition, congestive heart failure (female, OR: 4.076, 95% CI: 1.355-12.262, P = 0.012; male, OR: 5.676, 95% CI: 1.103-29.220, P = 0.038, resp.) and AKI (female, OR: 2.995, 95% CI: 1.355-6.621, P = 0.007; male, OR: 3.359, 95% CI: 1.158-9.747, P = 0.026, resp.) were significantly associated with risk of septic shock in both gender groups.

Conclusion: This study showed that patients with a medical history of CAD or CHF have a higher risk of shock when admitted for UTI treatment. AKI, a complication of UTI, was also associated with septic shock. Therefore, prompt and aggressive management is recommended for those with higher risks to prevent subsequent treatment failure in UTI patients.

No MeSH data available.


Related in: MedlinePlus