Obstructive urosepsis - is it possible to personalize the ureteral endoscopic treatment?

INTRODUCTION:Urinary tract infection involves mortality rate when combined to ureteral obstruction. Lithotripsy has been contraindicated, however it has been shown to be safe in selected situations. No specific criteria has been widely accepted to indicate which patients are suitable for definitive treatment. The cbjective of this study is to identify prognostic factors associated with poor outcome but also those patients whose definitive treatment can be performed. METHODS:observational cohort study from a prospectively maintained database of septic patients defined by the Sequential Organ Failure Assessment (SOFA). Univariate analysis was used to compare prognostic factors with Δ-SOFA score < 2 (group 1) and those with a Δ-SOFA≥2 (group 2) obtained on day 3 and on admission. Different combinations of neutrophils, lymphocytes and platelets were tested as prognostic factors. Time to decompression calculated from the CT scan report to end of surgery. RESULTS:229 patients were enrolled during 11 years. Two patients died. Time from CTscan to urinary tract decompression was higher in the Δ-SOFA≥2 (p=0.04). Thrombocytopenia and the platelet to lymphocyte ratio were associated with Δ-SOFA≥2. Stones were disintegrated in 33.48% in group 1 and 48.84% in group 2. Platelets count and time to decompression were associated with worse prognosis (p = 0.0008 and 0.0017). On ROC curve analysis, platelets count < 105,056 and time to decompression > 4.72hours linked to poorer outcome. CONCLUSIONS:Personalized treatment, based on accessible biomarkers can be achieved in most patients. Early surgical decompression was associated with better prognosis and definitive treatment can be performed in selected patients.