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Comprehensive Investigations of Multiple Factors That Are Related to Refractory Outcome in Urosepsis Patients.

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.