Development of a Predictive Nomogram for Sepsis in Patients with Urolithiasis-Related Obstructive Pyelonephritis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Patient Selection and Data Collection
2.3. Outcome Measures
2.4. Model Construction and Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Microbiology Results
3.3. Treatment and Outcomes
3.4. Variable Selection and Model Construction
3.5. Performance of the Nomograms and Bootstrap Internal Validation
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Total (n = 148) | Sepsis (n = 46) | Non-Sepsis (n = 102) | p Value |
---|---|---|---|---|
Age (year) | 60.8 ± 14.6 | 62.8 ± 13.6 | 59.9 ± 15.1 | 0.268 |
Male | 39 (26.4) | 14 (30.4) | 25 (24.5) | 0.449 |
SBP (mmHg) | 140.9 ± 33.3 | 122.9 ± 31.7 | 149.0 ± 30.8 | <0.001 * |
SBP < 90 (mmHg) | 8 (5.4) | 7 (15.2) | 1 (1.0) | <0.001 * |
Heart rate (beats/min) | 101.0 ± 20.8 | 109.2 ± 19.3 | 97.3 ± 20.5 | 0.001 * |
Heart rate > 100 (beats/min) | 72 (48.6) | 31 (67.4) | 41 (40.2) | 0.002 * |
Respiratory rate (beats/min) | 18.5 ± 2.0 | 19.2 ± 2.5 | 18.1 ± 1.7 | 0.007 * |
Shock index | 0.8 ± 0.3 | 0.9 ± 0.3 | 0.7 ± 0.2 | <0.001 * |
Fever † | 58 (39.2) | 21 (45.7) | 37 (36.3) | 0.279 |
Initial presentations | ||||
Abdominal pain | 21 (14.2) | 3 (6.5) | 18 (17.6) | 0.073 |
Flank or back pain | 86 (58.1) | 23 (50.0) | 63 (61.8) | 0.179 |
Urinary frequency | 1 (0.7) | 0 (0.0) | 1 (1.0) | 0.500 |
Dysuria | 19 (12.8) | 8 (17.4) | 11 (10.8) | 0.266 |
Hematuria | 11 (7.4) | 3 (6.5) | 8 (7.8) | 0.777 |
Comorbidities | ||||
Hypertension | 66 (44.6) | 21 (45.7) | 45 (44.1) | 0.862 |
Diabetes mellitus | 50 (33.8) | 22 (47.8) | 28 (27.5) | 0.015 * |
CAD | 12 (8.1) | 4 (8.7) | 8 (7.8) | 0.860 |
CKD | 21 (14.2) | 6 (13.0) | 15 (14.7) | 0.789 |
CHF | 4 (2.7) | 2 (4.3) | 2 (2.0) | 0.407 |
Malignancy | 14 (9.5) | 5 (10.9) | 9 (8.8) | 0.694 |
Prior stroke | 4 (2.7) | 2 (4.3) | 2 (2.0) | 0.407 |
Liver cirrhosis | 2 (1.4) | 1 (2.2) | 1 (1.0) | 0.561 |
Prior urolithiasis | 56 (37.8) | 12 (25.5) | 44 (32.8) | 0.351 |
Prior UTI | 16 (10.8) | 3 (6.5) | 13 (12.7) | 0.259 |
Prior APN | 12 (8.1) | 3 (6.5) | 9 (8.8) | 0.635 |
Blood test † | ||||
White blood count (103/µL) | 14.2 ± 8.3 | 17.2 ± 10.9 | 12.8 ± 6.4 | 0.014 * |
Bandemia (>3%) | 17 (11.5) | 12 (26.1) | 5 (4.1) | <0.001 * |
Hemoglobin (g/dL) | 12.2 ± 2.3 | 11.9 ± 2.4 | 12.4 ± 2.2 | 0.161 |
Platelet (103/µL) | 218.4 ± 117.4 | 193.2 ± 134.7 | 230.0 ± 107.4 | 0.078 |
C-reactive protein (mg/dL) | 12.9 ± 10.8 | 19.9 ± 9.8 | 9.9 ± 9.9 | <0.001 * |
Neutrophil to lymphocyte ratio | 16.2 ± 14.8 | 23.6 ± 20.3 | 12.9 ± 10.1 | <0.001 * |
Positive blood culture | 62 (41.9) | 28 (60.9) | 34 (33.3) | 0.002 * |
Urinalysis ‡ | ||||
Positive urinary nitrite | 54 (36.5) | 20 (43.5) | 34 (33.3) | 0.235 |
WBC (/HPF) | 14.2 ± 8.3 | 17.2 ± 10.9 | 12.8 ± 6.4 | 0.014 * |
RBC (/HPF) | 12.2 ± 2.3 | 11.9 ± 2.4 | 12.4 ± 2.2 | 0.161 |
Positive urine culture | 79 (53.4) | 28 (60.9) | 51 (50.0) | 0.220 |
CT findings | 0.525 | |||
Right-side stone | 13 (8.8) | 6 (13.0) | 7 (6.9) | |
Left-side stone | 16 (10.8) | 4 (8.7) | 12 (11.8) | |
Bilateral stone | 6 (4.1) | 1 (2.2) | 5 (4.9) | |
Degree of hydronephrosis | 0.239 | |||
Grade I–II | 97 (65.5) | 27 (58.7) | 70 (68.6) | |
Grade III–IV | 51 (34.5) | 19 (41.3) | 23 (31.4) | |
Location of stone | 0.514 | |||
Renal pelvis or UPJ | 41 (27.7) | 13 (28.3) | 28 (27.5) | |
Upper ureter | 44 (29.7) | 10 (21.7) | 34 (33.3) | |
Mid ureter | 12 (8.1) | 5 (10.9) | 7 (6.9) | |
Lower ureter | 16 (10.8) | 7 (14.9) | 9 (8.8) | |
Size of stone (mm) ‡ | 10.0 ± 10.4 | 9.5 ± 8.0 | 10.3 ± 11.3 | 0.668 |
Microorganism | n † | % |
---|---|---|
Blood cultures (n = 62) | ||
Escherichia coli (ESBL-producer) | 49 (15) | 70.0 (24.2) |
Klebsiella pneumoniae | 4 | 6.4 |
Proteus mirabilis | 3 | 4.8 |
Enterobacteriaceae | 2 | 3.2 |
Staphylococcus aureus | 1 | 1.6 |
Morganella | 1 | 1.6 |
Moraxella | 1 | 1.6 |
Serratia marcescens | 1 | 1.6 |
Pseudomonas aeruginosa | 1 | 1.6 |
Urine cultures (n = 79) | ||
Escherichia coli (ESBL-producer) | 50 (16) | 63.3 (20.3) |
Klebsiella pneumoniae | 7 | 8.9 |
Enterococcus faecalis | 4 | 5.1 |
Proteus mirabilis | 4 | 5.1 |
Yeast | 3 | 3.8 |
Pseudomonas aeruginosa | 3 | 3.8 |
Group B Streptococcus | 2 | 2.5 |
Citrobacter diversus | 2 | 2.5 |
Staphylococcus aureus | 2 | 2.5 |
Morganella | 1 | 1.3 |
Haemophilus | 1 | 1.3 |
Stenotrophomonas maltophilia | 1 | 1.3 |
Variable | Total (n = 148) | Sepsis (n = 46) | Non-Sepsis (n = 102) | p Value |
---|---|---|---|---|
Initial treatment | ||||
Antibiotic treatment only | 111 (75.0) | 33 (71.7) | 78 (76.5) | 0.538 |
PCN | 30 (20.3) | 12 (26.1) | 18 (17.6) | 0.237 |
Ureteral stent | 7 (4.7) | 3 (6.5) | 4 (3.9) | 0.490 |
URSL | 4 (2.7) | 1 (2.2) | 3 (2.9) | 0.790 |
In-hospital outcomes | ||||
Septic shock | 11 (7.4) | 11 (23.9) | 0 (0.0) | <0.001 * |
Intensive care unit admission | 2 (1.4) | 2 (4.3) | 0 (0) | 0.034 * |
Death | 2 (1.4) | 1 (2.2) | 1 (1.0) | 0.561 |
Length of stay | 10.6 ± 6.4 | 13.3 ± 7.1 | 9.3 ± 5.6 | <0.001 * |
No. | Age | Gender | Past Medical History | Symptoms | PCN | Operation | Antibiotic Therapy | Length of Stay (Days) | In-Hospital Mortality |
---|---|---|---|---|---|---|---|---|---|
1 | 52 | F | PUD | Left flank pain and dysuria | N | Y (ESWL) | D1–D3: Cefuroxime D4–D20: Piperacillin/Tazobactam | 20 | N |
2 | 74 | F | DM, HTN, Breast cancer | Right flank pain | N | Y (URSL + ureteral stent) | D1–D10: Ceftriaxone | 10 | N |
3 | 43 | F | N | Left back pain | N | N | D1–D2: Ceftriaxone D3–D9: Teicoplanin | 9 | N |
4 | 74 | F | DM, HTN, CHF, CKD | Fever | Y | N | D1–D14: Piperacillin/Tazobactam | 14 | N |
5 | 84 | M | HTN, DM | Hypotension | Y | N | D1–D2: Ceftriaxone + Metronidazole D3–D40: Imipenem/Cilastatin | 40 | Y |
6 | 54 | F | HTN, Endometrial cancer | Left flank pain and dysuria | N | N | D1–D11: Ertapenem | 11 | N |
7 | 66 | F | HTN, DM, Cervical cancer | Fever | N | N | D1–D3: Ceftriaxone D4–D20: Imipenem/Cilastatin | 20 | Y |
8 | 81 | F | DM, CKD | Fever and conscious disturbance | N | Y (URSL) | D1–30: Cefoperazone/Sulbactam | 30 | N |
9 | 70 | F | DM | Nausea and vomiting | Y | N | D1–D10: Ceftriaxone | 10 | N |
10 | 60 | M | DM | Fever | N | N | D1–D2: Ertapenem D3–D23: Teicoplanin | 23 | N |
11 | 70 | M | HTN, DM | Fever | N | N | D1–D5: Ceftriaxone D6–D23: Meropenem | 23 | N |
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Tsai, Y.-C.; Huang, Y.-H.; Niu, K.-Y.; Tsai, Y.-C.; Chen, C.-B.; Yen, C.-C. Development of a Predictive Nomogram for Sepsis in Patients with Urolithiasis-Related Obstructive Pyelonephritis. Medicina 2024, 60, 1113. https://doi.org/10.3390/medicina60071113
Tsai Y-C, Huang Y-H, Niu K-Y, Tsai Y-C, Chen C-B, Yen C-C. Development of a Predictive Nomogram for Sepsis in Patients with Urolithiasis-Related Obstructive Pyelonephritis. Medicina. 2024; 60(7):1113. https://doi.org/10.3390/medicina60071113
Chicago/Turabian StyleTsai, Yi-Chun, Yu-Hsuan Huang, Kuang-Yu Niu, Yu-Chen Tsai, Chen-Bin Chen, and Chieh-Ching Yen. 2024. "Development of a Predictive Nomogram for Sepsis in Patients with Urolithiasis-Related Obstructive Pyelonephritis" Medicina 60, no. 7: 1113. https://doi.org/10.3390/medicina60071113