Systemic inflammatory response syndrome in patients with acute obstructive upper tract urinary stone: a risk factor for urgent renal drainage and revisit to the emergency department.
Acute Disease
Adolescent
Adult
Aged
Aged, 80 and over
Drainage
Emergency Service, Hospital
Emergency Treatment
Female
Humans
Kidney Calculi
/ complications
Male
Middle Aged
Renal Colic
/ etiology
Retrospective Studies
Risk Factors
Systemic Inflammatory Response Syndrome
/ etiology
Ureteral Calculi
/ complications
Ureteral Obstruction
/ complications
Young Adult
Emergency department
Renal obstruction
SIRS
Ureteral colic
Urolithiasis
Journal
BMC urology
ISSN: 1471-2490
Titre abrégé: BMC Urol
Pays: England
ID NLM: 100968571
Informations de publication
Date de publication:
29 Jun 2020
29 Jun 2020
Historique:
received:
11
09
2019
accepted:
18
06
2020
entrez:
1
7
2020
pubmed:
1
7
2020
medline:
19
3
2021
Statut:
epublish
Résumé
In patients seen in the emergency department (ED) with acute stone obstruction many risk factors that indicate need for urgent renal drainage are known. However, in patients discharged from ED without renal drainage factors that can minimize revisit to the emergency department are not fully identified. We evaluated SIRS (systemic inflammatory response syndrome) as a risk factor for urgent renal drainage and revisit to the ED in patients with acute stone colic during their ED visit. Retrospective review was performed of patients presenting to a tertiary academic emergency department (ED) from an obstructing ureteral or UPJ stone with hydronephrosis confirmed on an abdominal and pelvic CT scan. Data evaluated over a 3-year period included stone size, presence of UTI, presence or absence of SIRS and other clinical variables as risk factors for urgent renal drainage and ED revisits. 1983 patients with urolithiasis were seen at the ED and 649 patients had obstructive urolithiasis on CT scan. SIRS was diagnosed in 15% (99/649) patients. 54/99 (55%) patients with SIRS underwent urgent renal drainage compared to 99/550 (17%) in non-SIRS patients. In a multivariate analysis SIRS was a predictor of urgent intervention compared to non-SIRS patients (odds ratio 4.6, p < 0.05). SIRS was also associated with increased risk for revisits to the ED (6.9% with SIRS vs. 2.4% with no SIRS, odds ratio 2.9, p = 0.05). Presence of SIRS in obstructive urolithiasis patients was an independent risk factor of acute urologic intervention and revisits to the ED. A timely consultation with a urologist following discharge from ED for obstructive stone patients with SIRS who had no acute renal drainage may prevent revisit to the ED. Evaluation for SIRS in addition to other clinical risk factors should be considered while making management decision in patients with acute stone obstruction.
Sections du résumé
BACKGROUND
BACKGROUND
In patients seen in the emergency department (ED) with acute stone obstruction many risk factors that indicate need for urgent renal drainage are known. However, in patients discharged from ED without renal drainage factors that can minimize revisit to the emergency department are not fully identified. We evaluated SIRS (systemic inflammatory response syndrome) as a risk factor for urgent renal drainage and revisit to the ED in patients with acute stone colic during their ED visit.
METHODS
METHODS
Retrospective review was performed of patients presenting to a tertiary academic emergency department (ED) from an obstructing ureteral or UPJ stone with hydronephrosis confirmed on an abdominal and pelvic CT scan. Data evaluated over a 3-year period included stone size, presence of UTI, presence or absence of SIRS and other clinical variables as risk factors for urgent renal drainage and ED revisits.
RESULTS
RESULTS
1983 patients with urolithiasis were seen at the ED and 649 patients had obstructive urolithiasis on CT scan. SIRS was diagnosed in 15% (99/649) patients. 54/99 (55%) patients with SIRS underwent urgent renal drainage compared to 99/550 (17%) in non-SIRS patients. In a multivariate analysis SIRS was a predictor of urgent intervention compared to non-SIRS patients (odds ratio 4.6, p < 0.05). SIRS was also associated with increased risk for revisits to the ED (6.9% with SIRS vs. 2.4% with no SIRS, odds ratio 2.9, p = 0.05).
CONCLUSIONS
CONCLUSIONS
Presence of SIRS in obstructive urolithiasis patients was an independent risk factor of acute urologic intervention and revisits to the ED. A timely consultation with a urologist following discharge from ED for obstructive stone patients with SIRS who had no acute renal drainage may prevent revisit to the ED. Evaluation for SIRS in addition to other clinical risk factors should be considered while making management decision in patients with acute stone obstruction.
Identifiants
pubmed: 32600324
doi: 10.1186/s12894-020-00644-z
pii: 10.1186/s12894-020-00644-z
pmc: PMC7325089
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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