Acute pyelonephritis (APN) with obstructive uropathy often causes sepsis. Recently, sepsis was redefined using the sequential organ failure assessment (SOFA) score, based on the new Sepsis-3 criteria. We investigated predictors for sepsis using this new definition in patients with obstructive APN associated with upper urinary tract calculi. We retrospectively evaluated patients who were admitted to our hospital for treatment of obstructive APN associated with upper urinary tract calculi. Blood and urine samples were collected before treatment of obstructive APN. Treatment included adequate antimicrobial therapy and emergency drainage to decompress the renal collecting system. We diagnosed sepsis using the new Sepsis-3 definition. We assessed predictors for sepsis by multivariate logistic regression analysis. Sixty-one patients were included in this study. Overall, all patients underwent emergency drainage, and 11 (18.0%) patients showed sepsis. There were no significant differences in performance status or comorbidities between sepsis and non-sepsis groups. Platelet count and serum albumin level were significantly lower in the sepsis group than in the non-sepsis group (p = 0.001 and p = 0.016, respectively). Procalcitonin (PCT) and presepsin (PSEP) levels were significantly higher in the sepsis group than in the non-sepsis group (p < 0.001 and p < 0.001, respectively). Multivariate analysis showed that PCT elevation (OR = 13.12, p = 0.024) and PSEP elevation (OR = 13.13, p = 0.044) were independent predictors for sepsis. Elevation of PCT and PSEP levels before treatment might predict the development of sepsis in patients with obstructive APN.

中文翻译：

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基于脓毒症-3的新定义的脓毒症中，预消化素和降钙素原可作为阻塞性急性肾盂肾炎的新指标

急性肾盂肾炎（APN）合并梗阻性尿毒症常引起败血症。最近，根据新的脓毒症3标准，使用序贯器官衰竭评估（SOFA）评分重新定义了脓毒症。我们使用这个新定义调查了患有上尿路结石的阻塞性APN患者的败血症预测因素。我们回顾性评估了入院接受上尿路结石梗阻性APN治疗的患者。治疗阻塞性APN之前应收集血液和尿液样本。治疗包括适当的抗微生物治疗和紧急引流以减轻肾脏收集系统的压力。我们使用新的Sepsis-3定义诊断败血症。我们通过多元逻辑回归分析评估了败血症的预测因子。本研究纳入了61名患者。总体而言，所有患者均进行了紧急引流，其中11例（18.0％）表现为败血症。败血症组和非败血症组之间的表现状态或合并症没有显着差异。败血症组的血小板计数和血清白蛋白水平显着低于非败血症组（分别为p = 0.001和p = 0.016）。败血症组的降钙素原（PCT）和胃蛋白酶（PSEP）水平显着高于非败血症组（分别为p <0.001和p <0.001）。多变量分析显示PCT升高（OR = 13.12，p = 0.024）和PSEP升高（OR = 13.13，p = 0.044）是脓毒症的独立预测因子。治疗前PCT和PSEP水平升高可能预示了阻塞性APN患者的脓毒症发展。