Risk Factors for Development of Septic Shock in Patients with Urinary Tract Infection.

ABSTRACT

INTRODUCTION: Severe sepsis and septic shock are associated with substantial mortality. However, few studies have assessed the risk of septic shock among patients who suffered from urinary tract infection (UTI). MATERIALS AND METHODS: This retrospective study recruited UTI cases from an acute care hospital between January 2006 and October 2012 with prospective data collection. RESULTS: Of the 710 participants admitted for UTI, 80 patients (11.3%) had septic shock. The rate of bacteremia is 27.9%; acute kidney injury is 12.7%, and the mortality rate is 0.28%. Multivariable logistic regression analyses indicated that coronary artery disease (CAD) (OR 2.521, 95% CI 1.129-5.628, P = 0.024), congestive heart failure (CHF) (OR 4.638, 95% CI 1.908-11.273, P = 0.001), and acute kidney injury (AKI) (OR 2.992, 95% CI 1.610-5.561, P = 0.001) were independently associated with septic shock in patients admitted with UTI. In addition, congestive heart failure (female, OR 4.076, 95% CI 1.355-12.262, P = 0.012; male, OR 5.676, 95% CI 1.103-29.220, P = 0.038, resp.) and AKI (female, OR 2.995, 95% CI 1.355-6.621, P = 0.007; male, OR 3.359, 95% CI 1.158-9.747, P = 0.026, resp.) were significantly associated with risk of septic shock in both gender groups. CONCLUSION: This study showed that patients with a medical history of CAD or CHF have a higher risk of shock when admitted for UTI treatment. AKI, a complication of UTI, was also associated with septic shock. Therefore, prompt and aggressive management is recommended for those with higher risks to prevent subsequent treatment failure in UTI patients.