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J Korean Soc Emerg Med > Volume 31(3); 2020 > Article
Journal of The Korean Society of Emergency Medicine 2020;31(3): 267-274.
일개 병원에서의 응급실을 방문한 패혈성 폐쇄성 요로감염 환자에 대한 고찰
박재형1 , 김성훈1 , 최마이클승필1 , 제동욱1 , 노우영1 , 박홍인1 , 신수정1 , 박용석1 , 박창원1 , 이미진2 , 안재윤2 , 이동언2 , 문성배2 , 김창호2 , 이숙희3
1차의과학대학교 구미차병원 응급의학과
2경북대학교 의학전문대학원 응급의학교실
3대구가톨릭대학교 의과대학 응급의학교실
A single emergency center study for obstructive urinary tract infection with sepsis
Jae Hyung Park1 , Seong Hun Kim1 , Michael Sung Pil Choe1 , Dong Wook Je1 , Woo Young Nho1 , Hong In Park1 , Su Jeong Shin1 , Yong Seok Park1 , Chang Won Park1 , Mi Jin Lee2 , Jae Yun Ahn2 , Dong Eun Lee2 , Sungbae Moon2 , Chang Ho Kim2 , Suk Hee Lee3
1Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, Gumi, Korea
2Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
3Department of Emergency Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
Correspondence  Seong Hun Kim ,Tel: 054-450-9997, Fax: 054-450-9886, Email: junram@nate.com,
Received: July 1, 2019; Revised: September 30, 2019   Accepted: October 18, 2019.  Published online: June 25, 2020.
Unlike common acute urinary tract infections, obstructive urinary tract infections caused by urinary calculus can be fatal because they can progress to sepsis and cause shock or disseminated intravascular coagulation. The evidence of patients with obstructive urinary tract infections caused by urinary tract stones visiting the emergency center is still lacking.
Seventy-seven patients who visited the emergency room with obstructive urinary tract infections caused by urinary calculus from January 2016 to December 2018 were enrolled in this study and divided into two groups: sepsis group and non-sepsis group.
The lymphocyte count, platelet count, neutrophil-lymphocyte ratio, serum creatinine, and C-reactive protein were significantly different in the sepsis-positive and negative groups. Percutaneous nephrostomy was also significantly higher in the sepsis-positive group. The area under the receiver operating characteristic curve was calculated to evaluate the ability of the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio to predict a septic urinary tract infection. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were 0.659 and 0.550, respectively. Multivariate logistic regression analysis showed that diabetic patients, percutaneous nephrostomy, and serum creatinine were associated with septic obstructive urinary tract infection.
In patients with an obstructive urinary tract infection who were referred to the emergency center, diabetic patients and those with high blood urea nitrogen and creatinine levels are at high risk of sepsis. In such cases, rapid diagnosis and treatment, such as percutaneous nephrostomy, are necessary.
Key words: Sepsis; Urinary tract infections; Urinary calculi
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