| Emergency nephrectomy due to severe urosepsis: a retrospective, multicentre analysis of 65 cases. | |
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MedLine Citation:
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PMID: 19338556 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To assess the outcome of emergency nephrectomy in a retrospective, multicentre analysis, as emergency nephrectomy due to life-threatening urosepsis is a rare clinical scenario with a high mortality, and there are few reports of clinical data on this issue. PATIENTS AND METHODS: We assessed retrospectively all patients who had a nephrectomy due to life-threatening urosepsis in three referral centres in Vienna between 1994 and 2007. Patient characteristics, survival and risk factors for a fatal outcome were evaluated. RESULTS: In all 65 patients (44 women and 21 men; mean age 65 years) were analysed. The mean interval from the first medical consultation to hospital admission was 4.3 days. Two-thirds of patients were admitted directly from their homes (63%), the remainder being transferred from other departments or hospitals. The most common pathological mechanism leading to urosepsis was acute pyelonephritis, often combined with nephrolithiasis. In all, 36 patients had a urological intervention before nephrectomy, i.e. percutaneous nephrostomy in 17, ureteric stent in 16 and percutaneous abscess drainage in three. Nephrectomy was performed a mean (range) of 5.7 (0-31) days after hospital admission. Thirteen patients (20%) died from septic multi-organ failure after surgery. This group was almost 20 years older than those who survived (78.6 vs 61.8 years), had a higher comorbidity rate, had undergone endourological interventions more frequently (69% vs 52%), had a longer interval to nephrectomy (6.9 vs 5.4 days), higher C-reactive protein level (294.9 vs 136.0 mg/L) and lower platelet counts (229.5 vs 307.7 million/L) at diagnosis. CONCLUSION: Several factors were identified that influence the outcome after emergency nephrectomy for life-threatening urosepsis. Applied to the decision-making process, these risk factors could have a positive impact on establishing a timely indication for nephrectomy that might ultimately reduce the high mortality rate. |
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Authors:
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Ingrid Berger; Sonja Wildhofen; Alexander Lee; Anton Ponholzer; Michael Rauchenwald; Othmar Zechner; Walter Stackl; Stephan Madersbacher |
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Publication Detail:
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Type: Journal Article; Multicenter Study Date: 2009-03-18 |
Journal Detail:
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Title: BJU international Volume: 104 ISSN: 1464-410X ISO Abbreviation: BJU Int. Publication Date: 2009 Aug |
Date Detail:
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Created Date: 2009-07-20 Completed Date: 2009-09-01 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100886721 Medline TA: BJU Int Country: England |
Other Details:
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Languages: eng Pagination: 386-90 Citation Subset: IM |
Affiliation:
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Department of Urology and Andrology, Donauspital, Vienna, Austria. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over C-Reactive Protein / metabolism Child Emergencies Epidemiologic Methods Female Humans Kidney Diseases / complications, mortality, surgery* Male Middle Aged Nephrectomy / methods* Sepsis / etiology, mortality, surgery* Treatment Outcome Urinary Tract Infections / complications, mortality, surgery* Young Adult |
| Chemical | |
Reg. No./Substance:
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9007-41-4/C-Reactive Protein |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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