The prognostic significance of risk factors for the progression of urosepsis, Прогностичне значення факторів ризику в перебігу уросепсису

<jats:p>Background. Urosepsis is a life-threatening organ dysfunction caused by a disruption in the regulation of the response to a urinary tract infection. The main risk factors for the development of urosepsis are urinary tract obstruction at any level, congenital uropathies, neurogenic bladder, and endoscopic procedures on the urinary tract. The purpose of the study was to assess risk factors leading to fatal outcomes in patients with urosepsis. Materials and methods. A retrospective analysis was conducted of the factors contributing to mortality from urosepsis in 80 patients, who were divided into three groups based on the age criteria defined by the WHO: group I (n = 20) — middle-aged patients, from 46 to 60 years (mean age 51.2 ± 6.1 years); group II (n = 41) — elderly patients aged 60 to 75 years (66.7 ± 4.8 years) and group III (n = 19) — senile patients aged 75 to 90 years (78.5 ± 3.1 years). The study was conducted in accordance with the requirements and criteria of evidence-based medicine, in compliance with the Declaration of Helsinki, and was approved by the Bioethics Committee of Kharkiv National Medical University. Results. When analyzing the relationship between factors complicating the course of urosepsis depending on the patients’ age, inverse moderate correlations can be noted between bilateral urolithiasis and cardiac pathology (r = –0.50, p = 0.02) in middle-aged patients and a positive moderate correlation between pyelonephritis and cardiac pathology (r = 0.35, p = 0.02) in elderly patients. The Charlson Comorbidity Index in middle-aged patients showed a moderate correlation with obesity (r = 0.58, p = 0.007) and diabetes mellitus (r = 0.62, p = 0.003), whilst in the elderly, it was associated only with cardiac pathology (r = 0.42, p = 0.01). The CIRS comorbidity score correlated directly with diabetes mellitus in both middle-aged (r = 0.59, p = 0.006) and elderly (r = 0.41, p = 0.01) patients. As for senile patients, a moderate correlation was found between genitourinary diseases and cardiac pathology (r = –0.54; p = 0.02). Conclusions. The most common risk factor for urosepsis was urolithiasis (70 %). The severe course and mortality in patients were due to a high correlation and significant influence of cardiac pathology (r = 0.80, p = 0.00003), diabetes mellitus (r = 0.90, p &lt; 0.001) and obesity (r = 0.93, p = 0.02). Despite the timely provision of inpatient medical care and conducting surgical interventions, including percutaneous nephrostomy (43 %), nephrectomy (17.5 %) and renal decapsulation (13.8 %), no positive outcome was achieved due to patients presenting late.</jats:p>