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Authors
Sejima, Takehiro Department of Urology, Matsue-city Hospital
Masago, Toshihiko Department of Urology, Matsue-city Hospital
Morizane, Shuichi Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University Researchers DB KAKEN
Honda, Masashi Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University Researchers DB KAKEN
Takenaka, Atsushi Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University Researchers DB KAKEN
Keywords
sepsis
urinary tract infection
urosepsis
Abstract
Background: Urosepsis is an acute life-threating disease, and some cases show refractory outcome to therapy. In an aging society of developed countries, characteristics of urosepsis are becoming complicated. We performed a comprehensive investigation regarding the clinical and social aspects that are related to refractory outcomes in urosepsis patients. Methods: The patient cohort consisted of 66 patients with urosepsis. Multiple factors from clinical and social aspects were reviewed retrospectively. Two categories of refractory outcomes were defined. One was afebrile resistance (AR); fever continued more than 7 days from the initiation of therapy. Another was discharge resistance (DR); hospitalization continued for more than 30 days. Logistic regression analyses were performed to identify significant factors that are related to the AR or DR. Results: Univariate analysis demonstrated that high score of Eastern Cooperative Oncology Group Performance Status (ECOG PS) (? 2) and Age-adjusted Charlson comorbidity index (CCI) (? 4), high serum C-reactive protein (CRP) level (? 14.9 mg/dL), and low serum albumin level (? 2.26 g/dL) were significantly related to AR. Univariate analysis results also revealed that high score of ECOG PS (? 2), high serum creatinine level (? 1.54 mg/dL) and vasopressor administration were significantly related to DR. Multivariate analyses demonstrated that low serum albumin level (? 2.26g/dL) was the only significant factor that was related to AR. In contrast, high score of ECOG PS (? 2) and high serum creatinine level (? 1.54 mg/dL) were significant factors that were related to DR. Conclusion: It is suggested that evaluating serum albumin levels is essential for the therapeutic first step because hypoalbuminemia was the significant factor that was related to obstruction to antipyresis. It is also suggested that the deterioration of patients’ activities of daily living and renal dysfunction might be the refractory factors for discharge from the hospital, which was the ultimate therapeutic goal.
Publisher
Tottori University Medical Press
Content Type
Journal Article
Link
ISSN
05135710
EISSN
13468049
NCID
AA00892882
Journal Title
Yonago Acta Medica
Current Journal Title
Yonago Acta Medica
Volume
65
Issue
3
Start Page
254
End Page
261
Published Date
2022-08-29
Publisher-DOI
Text Version
Publisher
Rights
(C) 2022 Tottori University Medical Press.
Citation
Yonago Acta Medica. 2022, 65(3), 254-261. doi10.33160/yam.2022.08.012
Department
Faculty of Medicine/Graduate School of Medical Sciences/University Hospital
Language
English