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Moderated Poster
Muhannad Alsyouf, MD
Loma Linda University Medical Center
Presentation Authors: Muhannad Alsyouf*, Phillip Stokes, Soungmin Cho, Zachary Gilbert, Akin Amasyali, Mohammad Hajiha, Milan Shah, Jason Groegler, D Duane Baldwin, Loma Linda, CA
Introduction: Infection associated with obstructing stones is a urologic emergency due to the risk of worsening sepsis and potential for mortality without prompt decompression. The Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed as a predictor of severity of organ dysfunction in patients with sepsis but has not been validated in patients presenting with obstructive pyelonephritis requiring decompression. The purpose of this study is to evaluate peri-operative factors, including qSOFA scores, and their association with postoperative outcomes including the need for ICU admission.
Methods: A retrospective review of 100 consecutive patients presenting to a single tertiary care academic medical center with obstructive pyelonephritis secondary to ureteral stones was performed. Obstructive pyelonephritis was defined as obstructing ureteral stone associated with urinary tract infection and/or signs of sepsis. All patients underwent emergent ureteral stent placement for decompression. ICU admission criteria included hypotension requiring vasopressor support and/or respiratory failure requiring mechanical ventilation. Univariate analysis and multivariate regression analysis were performed to identify factors associated with ICU admission, with p < 0.05 considered significant.
Results: One hundred patients presented with obstructive pyelonephritis requiring emergent ureteral stent placement, with 15 patients requiring subsequent ICU admission. Patients requiring ICU admission were significantly older (average 63.4 vs. 49.1 years; p < 0.01), had higher pre-operative heart rate (average 136.0 vs. 102.6; p < 0.01), higher initial WBC count (average 16.8 vs. 12.6; p < 0.01), higher rate of pre-operative hypotension (80.0% vs. 37.6%; p < 0.01), and qSOFA score ≥2 (86.7% vs. 20.3%; p < 0.01) compared to patients that did not require ICU admission postoperatively. Patients with pre-operative q-SOFA scores ≥2 had significantly longer hospital stays (average 6.1 vs. 4.5 days; p=0.02). On multivariate analysis, pre-operative q-SOFA score ≥2 was the only significant predictor of ICU admission postoperatively (OR 11.8 [95% CI 1.07-130.0]).
Conclusions: Higher qSOFA scores significantly predict the need for ICU admission in patients undergoing ureteral stent placement for obstructed infected stones. This study validates the qSOFA scoring system during the initial evaluation of patients presenting with obstructive pyelonephritis.