Risk factors of urinary sepsis after mPCNL in patients with negative preoperative urine culture / 现代泌尿外科杂志

【Objective】 To determine the risk factors of urinary sepsis secondary to minimally invasive percutaneous nephrolithotomy (mPCNL) in patients with negative preoperative urine culture (UC). 【Methods】 A total of 274 patients with negative preoperative UC treated with mPCNL during Jan.2016 and Jun. 2021 were retrospectively analyzed. The incidence of urinary sepsis was observed, and the general data of patients with or without urinary sepsis after mPCNL were compared. logistic regression model was used to analyze the risk factors of urinary sepsis after mPCNL. 【Results】 Urinary sepsis occurred in 11 cases (4.01%). Univariate analysis showed that urinary sepsis was associated with gender, body mass index, stone load, diabetes, urine WBC ≥2+, urinary nitrite, procalcitonin, and operation time. Multivariate logistic regression analysis showed that the independent risk factors of urinary sepsis after mPCNL included diabetes (OR=2.34, 95%CI=1.051-5.43, P=0.037), stone load (OR=7.51, 95%CI=3.17-7.38, P=0.045), urine WBC≥2+ (OR=4.57, 95%CI=6.75-11.38, P=0.032), urinary nitrite positive (OR=6.45, 95%CI=0.93-26.87, P=0.028) and operation time≥120 min (OR=3.53, 95%CI=1.41-8.85, P=0.042). 【Conclusion】 Diabetes, stone load, urinary WBC ≥2+, positive urinary nitrite and operation time ≥120 minutes are the risk factors of urinary sepsis after mPCNL in patients with negative urine culture.

Research progress on early diagnositic biomarkers of urinary sepsis / 中华泌尿外科杂志

The accuracy of the Sepsis-3 definition in the diagnosis of sepsis has been widely accepted and applied. Indicators such as Procalcitonin(PCT), white blood cell(WBC), C-reactive protein(CRP), platelets(PLT) and albumin are the most extensively and conveniently applied in early alert and diagnosis of urinary sepsis. PCT has a higher specificity and sensitivity compared to other biomarkers, and a sharp drop in WBC is a strong warning for septic shock. However, CRP has a relatively low specificity. IL-6, CD64, Presepsin, miRNA, and PTX-3, among others, are more valuable emerging indicators with higher sensitivity and specificity. However, uniform and standardized technology is necessary for a high quality testing. The combination of multiple biomarkers with a clinical scoring system is more useful than individual biomarkers clinically. This article mainly reviewed the progress of research on indicators related to early alert and diagnosis of urinary sepsis during recent years.

Association of inflammatory indices with the severity of urinary sepsis: analysis of 70 cases / 南方医科大学学报

OBJECTIVE@#To analyze the association of the clinical inflammatory indices with the severity of urinary sepsis.@*METHODS@#We reviewed the clinical data of 70 patients with urinary sepsis treated in our hospital between January, 2013 and April, 2018. All the patients were diagnosed in line with the Guidelines for Diagnosis and Treatment of Urological Diseases in China (2014 edition), including 22 patients with sepsis, 12 with hypotension and severe sepsis, 17 with septic shock, and 19 with critical septic shock. White blood cell count (WBC), neutrophil percentage (N%), platelets (PLT), fibrinogen (FIB), Ddimer, interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) were examined in all the cases and compared among the 4 groups. The correlations of these inflammatory markers with the severity of sepsis were analyzed using logistic regression analysis.@*RESULTS@#The 4 groups of patients showed significant differences in N%, PLT, D-dimer, and PCT ( < 0.05) but not in CRP (>0.05). Kruskal-Wallis Pairwise comparisons showed that the N% and PCT in patients with sepsis differed significantly from those in the other 3 groups; platelets in patients with sepsis differed significantly from those in patients with septic shock and critical septic shock; D-dimer differed significantly between patients with sepsis and those with septic shock. Among the 4 groups, the median levels of PLT decreased and PCT and N% increased with the worsening of sepsis. Logistic regression analysis indicated that PCT (=0.186, =0.000), N% (=0.047, =0.035) and PLT (=-0.012, =0.003) were significantly correlated with the severity of sepsis in these patients.@*CONCLUSIONS@#PCT, PLT and N% are all significantly correlated with the severity of sepsis, and their combined detection can be informative for assessing the severity of sepsis to facilitate clinical decisions on treatment.

Effect of early continuous renal replacement therapy on the prognosis of urosepsis / 中华泌尿外科杂志

Objective To investigate the effect of early continuous renal replacement therapy on the prognosis of urinary sepsis after surgery for upper urinary tract calculi.Methods The clinical data of 59 patients with urinary sepsis after surgery for upper urinary tract calculi were retrospectively analyzed.In 59 patients with urinary sepsis,9 patients with early persistent renal replacement therapy were selected as the experimental group and 50 patients without early continuous renal replacement therapy as the control group. The age,sex ratio,diabetes,hypertension,the average operation time were no significant difference(P>0.05).Preoperative urinary tract infection,the experimental group preoperative urinary tract infection was significantly higher than the control group(77.8% vs.32.0%,P<0.05).In the results of preoperative urine culture positive ratio,the experimental group was also significantly higher than the control group,the difference was statistically significant(P<0.05).The changes of prognostic factors in patients with or without continuous renal replacement therapy were analyzed.Results In terms of the changes of postoperative laboratory results,the decrease of procalcitonin(PCT),C-reactive protein,white blood cell count and neutrophil ratio in the experimental group was significantly larger than that in the control group, and the difference was statistically significant;on the increase of hemoglobin,platelet count,fibrinogen,the standard bicarbonate level from blood gas analysis in the experimental group increased significantly more than the control group,the difference between the two groups were statistically significant.Conclusions Early renal replacement therapy in patients with urinary sepsis after upper urinary tract calculi surgeries can improve the prognosis of patients.

Urinoma, un traumatismo olvidado / Urinoma: a forgetful trauma

Se presentó un paciente con APP de hipertensión arterial desde hace 15 años que 2 meses antes del ingreso comenzó a padecer cuadros de decaimiento, disminución del apetito, disuria y escalofríos. Se le diagnosticó sepsis urinarias a repetición, sin mejoría clínica. Al ingresar, presentaba aumento de volumen de los miembros inferiores, principalmente en horas de la tarde, pérdida de peso de, aproximadamente, 20 libras y dolor en hemiabdomen superior. Se describió la evolución clínica y los estudios realizados mediante los cuales se le diagnosticó la presencia de: urinoma infestado, sepsis urinaria, hiperplasia benigna de próstata y litiasis renal bilateral con hidronefrosis complicada con insuficiencia renal

This is the case of a patient presenting with APP of high blood pressure from 15 years ago that two months before admission suffered from weakness, lost of appetite, dysuria and shivers and also diagnosing repeated urinary sepsis without clinical improvement. At admission, patient showed an increase in volume of lower extremities mainly in the afternoon, weight loss of approximately 20 pounds and pain in the superior hemi-abdomen. We describe the clinical course and the studies conducted served to diagnose the presence of: infected urinoma, urinary sepsis, prostatic benign hyperplasia and bilateral renal lithiasis with hydronephrosis complicated by renal failure

Factores de riesgo asociados al bajo peso al nacer / Risk factors associated to low birth weight

Se efectuó un estudio de casos y controles de 210 puérperas cuyos hijos nacieron pesando menos de 2 500 gramos (grupo de estudio) en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el 2008, para identificar los factores de riesgo asociados al bajo peso al nacer. Los tomados como controles se escogieron a partir de un muestreo aleatorio sistemático por orden de consecutividad en dicho período. Entre los factores de riesgo causantes de ese déficit ponderal figuraron: procedencia rural, ganancia insuficiente de peso materno, período intergenésico menor de 2 años, hipertensión inducida por el embarazo y edad gestacional por debajo de 37 semanas. Las afecciones respiratorias y las infecciones vaginales constituyeron las principales causas de morbilidad; y la sepsis urinaria, de mortalidad.

A case-control study of 210 newly-delivered women whose children were born weighting less than 2 500 grams (study group) was carried out in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital from Santiago de Cuba, during the 2008, to identify the risk factors associated with low birth weight. The control group was chosen from a systematic random sampling by consecutive order in this period. Among the causative risk factors of that deficit there were: rural origin, low gain of maternal weight, period between pregnancies shorter than 2 years, pregnancy induced hypertension and gestational age under 37 weeks. Breathing disorders and the vaginal infections constituted the main morbidity causes; and the urinary sepsis, the main mortality cause.