Factors influencing the flare of inflammatory markers after drainage of obstruction for patients with obstructive urosepsis
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Objective: To analyze risk factors associated with the flare of inflammatory markers after drainage of obstruction for patients with obstructive urosepsis(OUs) and evaluate the laboratory tests for early judgement of patients’ outcome. Methods: We conducted a retrospective study including patients with OUs who received surgical decompression of obstruction in our center between February 2017and January 2022.All patients were categorized into two groups based on whether inflammatory markers flare or not after relief of obstruction. Analysis of patients’ characteristics, manner of decompression and laboratory tests were performed. Results: A total of 81 patients were enrolled in this study and we identified 43 cases(53.9%) with serum leukocytes flare. The only risk factor for the flare of serum leukocytes in multivariate analyses was shock（OR=9.116,95%CI=3.028-27.438,P＜0.001）. The receiver operating characteristic curve of multivariate model showed an area of 0.796，95%CI 0.699-0.893,P＜0.001. Patients with shock were found to flare significantly more frequently when compared to those without shock for neutrophil (NEUT)（OR=6.324,95%CI=2.103-19.011,P＝0.001）and serum creatinine(Scr)（OR=2.714,95%CI=2.022-3.643,P＝0.009. Outcome analysis suggested that decreased Scr acted as a leading indicator for the early remission of sepsis（n=76，93.8%）. Conclusion: The flare of leukocytes after drainage of obstruction may reflect the dysregulated migration of neutrophils caused by severe urosepsis rather than the results of decompressed procedure or exacerbated retrograde infection. Decreased serum creatinine may serve as an ideal predictor for the early detection of remission.
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Methods We conducted a retrospective study including patients with OUs who received surgical decompression of obstruction in our center between February 2017and January 2022.All patients were categorized into two groups based on whether inflammatory markers flare or not after relief of obstruction. Analysis of patients’ characteristics, manner of decompression and laboratory tests were performed. Results A total of 81 patients were enrolled in this study and we identified 43 cases(53.9%) with serum leukocytes flare. The only risk factor for the flare of serum leukocytes in multivariate analyses was shock（OR=9.116,95%CI=3.028-27.438,P＜0.001）. The receiver operating characteristic curve of multivariate model showed an area of 0.796，95%CI 0.699-0.893,P＜0.001. Patients with shock were found to flare significantly more frequently when compared to those without shock for neutrophil (NEUT)（OR=6.324,95%CI=2.103-19.011,P＝0.001）and serum creatinine(Scr)（OR=2.714,95%CI=2.022-3.643,P＝0.009. Outcome analysis suggested that decreased Scr acted as a leading indicator for the early remission of sepsis（n=76，93.8%）. Conclusion The flare of leukocytes after drainage of obstruction may reflect the dysregulated migration of neutrophils caused by severe urosepsis rather than the results of decompressed procedure or exacerbated retrograde infection. Decreased serum creatinine may serve as an ideal predictor for the early detection of remission. Acute upper urinary tract obstruction Emergent drainage Urosepsis Leukocytes Serum creatinine Figures Figure 1 Introduction Obstructive urosepsis(OUs) is a severe septic pathology that can potentially lead to death, the most common obstructive factor is ureteral stone, other rare risk factors including urethral stricture, ureteral tumors et.al 【 1 , 2 】 . Prompt renal decompression and antibiotics are considered as the gold standard in the treatment of OUs 【 3 】 . Meanwhile, we require objective biomarkers to serve as indicators of response to the therapeutic intervention. A large armamentarium of serum sepsis biomarkers has been reported over the past years 【 4 】 , however, a majority of tests are experimental, costly and not commonly available in the emergent department in a timely manner 【 5 】 . Leukocytosis still plays a vital role in predicting the risk of sepsis and triggering surgical decompression of OUs 【 6 】 . In addition, urologists usually determine the therapeutic outcome based on the dynamic change of leukocyte counts(WBC). In clinical practice, we observed distinct changes of WBC count among different patients in the perioperative period. Herein, the primary aim of the present study was to analyze the risk factors which cause the flare of WBC count after obstructive decompression. The secondary aim was to evaluate the objective biomarker predicting early remission of OUs. Materials And Methods Data source This retrospective observational single-center study was performed in the Department of urology of the Ruijin Hospital ,Shanghai Jiaotong University School of Medicine, Shanghai, China. The study was approved by the local ethics committee and the requirement for informed consent was waived due to the retrospective study design.Data were collected in the period between February 2017 and January 2022. All patients were diagnosed with urosepsis based on the criteria of Sepsis 2 【 7 】 and were categorized into two groups according to whether inflammatory markers flare or not after relief of obstruction. Patients were only included if they underwent decompression with percutaneous nephrostomy(PCN)or retrograde ureteric stent(RUS) for concern of infection combined with obstructive urolithiasis. This was determined based on review of clinical documentation and procedure indications. Patients undergoing urinary decompression for other indications (e.g. tumor compression ,acute kidney injury, etc.), as well as suffered from hematologic diseases or concomitant infection in other organs were excluded. Patients who did not undergo decompression or received one-stage holmium laser lithotripsy, and patients with missing data were also excluded from the analysis. Diagnosis and management of OUs The diagnosis of OUs was determined clinically in accordance with the sepsis criteria. All patients enrolled in the study were received urgent PCN or RUS under local anesthesia. A urine sample was taken from the obstructed kidney. Meanwhile, intravenous antibiotics by carbapenems were treated initially upon their admission to the emergency department. All patients underwent laboratory investigations including routine blood test, C-reactive protein, procalcitonin, renal function, liver function, blood electrolyte, coagulative function on the day prior to surgery and on the first postoperative day respectively. Urine test and urine cultures were also assessed before the decompression. Prolonged coagulating time(CT) was defined as APTT＞39.5s or PT＞15s. Description of inflammatory markers flare Flare of inflammatory markers was defined as rising WBC count, percentage of neutrophils（NEUT%）, C-reactive protein（CRP）,procalcitonin(PCT),serum creatinine(Scr) or decreased platelet count(PLT) on the 1 st day postoperatively compared with its level on the day received decompression. Patients were also included into the flare group for those CRP or PCT consecutively demonstrating out of measure. Statistical analysis SPSS19.0 statistical software was used for data analysis. Continuous data were expressed as mean ± SD. Univariate analysis of predictors of flare was done using Pearson chi-square test, Student's sample t-test or Mann Whitney U test as appropriate. The P value and relative ratio were calculated for risk factors. Multivariate analysis was done using logistic regression analysis. The discriminatory power of risk factors was determined by the area under the receiver operating characteristic curve (ROC) with corresponding 95% CIs. P< 0.05 was defined as a statistically significant difference. Results Baseline characteristics and outcomes This study included 81 patients with OUs. In total,63(77.77%) were admitted for decompression with RUS，and18 (22.22%)patients underwent drainage of PCN. The baseline characteristics, laboratory data and prognosis of patients are summarized in Table 1. There was no significant difference in age, sex, diabetes mellitus ,fever, stone side, positive UTI, positive urine culture and decompressed manner between WBC flare group and non-flare group(P > 0.05; Table 1) . Univariable and multivariable associations with leukocytes flare In our cohort, WBC count levels, CRP levels and prolonged coagulating time show no correlation with leukocytes flare in univariate analysis(P＞0.05). In the further univariate logistic regression analysis，pre-operative shock (OR=9.00,95%CI=3.09-26.211, P＜0.001）, NEUT＞90%（(OR=4.375,95%CI=1.614-26.11.859, P＝0.003）, decreased PLT(110.26±61.80vs 160.61±88.2, P＜0.001), elevated CCI scores（3.74±2.21vs2.74±1.84, P=0.03）,NEUT （92.08±4.15vs88.99±5.34, P=0.005）and procalcitonin（55.78±33.60vs31.08±29.97, P＜0.001） were found to be significantly associated with the occurrence of leukocytes flare (Table 1). On forward stepwise multivariable logistic regression, preoperative shock was the only independent risk factor for leukocytes flare（OR=9.116,95%CI=3.028-27.438, P＜0.001）(Table 2). The AUC for the multivariate regression model (Predicted Probability, PRE)was 0.796，95%CI 0.699-0.893, P＜0.001(Figure 1). The analysis of flare in other inflammatory markers With respect to the flare of other inflammation-associated markers, analysis revealed that the risk of flare varied greatly, with flares being most common in PLT（61.73%）, and being rarest in Scr(6.17%) (Table 3). Relationship between the flare of WBC, NEUT, PLT, CRP, PCT, Scr and shock was analyzed in the univariate analysis. Patients with shock were found to flare significantly more frequently when compared to those without shock in NEUT （OR=6.324,95%CI=2.103-19.011, P＝0.001）and Scr（OR=2.714,95%CI=2.022-3.643, P＝0.009）. Our study did not show any correlation between shock and flare of PLT,CRP or PCT(P＞0.05)(Table 3). Discussion Obstructive urosepsis is a life-threatening organ dysfunction caused by an overwhelming host immune response associated with organic or functional urinary tract abnormalities such as urinary stones, stenosis or tumors 【 2 , 8 】 .It can cause severe conditions such as septic shock and disseminated intravascular coagulopathy (DIC) 【 9 】 . It is accepted that urgent drainage of the obstructed system with retrograde ureteric stent (RUS)or percutaneous nephrostomy ༈PCN༉ can reduce intrarenal pressure and improve prognosis 【 10 , 11 】 . With respect to the technique of surgical decompression, it has always been in active debate 【 12 – 14 】 . Several results demonstrated that PCN is superior to RUS for emergent drainage of OUs. One area of theoretical concern is the risk of instrumentation and worsening urosepsis when performing retrograde stenting 【 15 , 16 】 .However, to date, the literature does not support this hypothesis and most studies failed to confirm the superiority and inferiority between these two techniques 【 11 , 14 】 . Similarly, our present study could not show different clinical outcome between the technique of RUS and PCN. It is noteworthy that emergent drainage may inevitably cause aggravating bacteremia temporarily under certain conditions. Nevertheless, both PCN and RUS could trigger the transient fluctuation equally 【 14 】 and bacteremia will be eliminated timely under synchronous protection of effective antibiotics. One another superiority of PCN over RUS ,it is deemed that the former procedure could be undertaken with local anaesthesia only, whereas the latter one was usually performed under general anaesthesia, 【 6 , 14 】 . Therefore, the application of RUS may be restricted to patients with severe or refractory septic shock who have contraindication under general anaesthesia. In the present study, we performed all RUS under local anaesthesia, no operative interruption or accident was recorded, we considered RUS under local anaesthesia has satisfactory safety and tolerance. However, it is important to note that all these patients should be guaranteed under conscious state and possess the ability of following instructions. To detect patients required prompt decompression earlier, we included patients with OUs based on the criteria of systemic inflammatory response syndrome (SIRS) not qSOFA. Measuring routine blood count is a convenient and quickly approach which contribute to reflect the systemic inflammatory response to infection and evaluate the therapeutic efficiency 【 6 】 . Leukocytosis (more than 12.0 *10 9 /L) or leukopenia (lower 4.0 *10 9 /L) has been included in the diagnostic criteria of SIRS 【 7 】 . Similarly, NEUT% and PLT count were also demonstrated as biomarkers evaluating the severity of infection. Prior study showed that decreases in the platelet count were independent risk factors for septic shock 【 17 】 . Additionally, lower platelet to leucocytic count ratio (PLR) was considered as an independent simple predictor for sepsis and mortality in patients with sepsis or emphysematous pyelonephritis 【 18 , 19 】 .Nevertheless ,it is notable that even in bacteremic patients with hypotension or septic shock, 21% had a normal WBC count on initial evaluation, suggesting that these parameters are relatively insensitive even in the case of severe physiologic derangement 【 20 】 . On the contrary, some patients without infection may present high blood leukocyte counts in the proper clinical scenario, such as simple renal colic. Although its limitation in insufficient sensitivity and specificity, WBC count play a vital and fundamental role in evaluate the severity and the disease course of sepsis 【 6 】 . Furthermore, the dynamic change of WBC before and after drainage was always clinically applied as a predictive marker in determining the therapeutic effects for patients with OUs. In theory, eliminating the influencing effect of surgical procedure, WBC counts should be totally decreased progressively after the decompression of OUs. However, our data demonstrated distinct variation in WBC around the drainage, a cohort of patients manifest WBC flare though with elevated or normal value on the day of procedure, while other patients show progressive decrease. Similar flare of other biomarkers related to sepsis was also identified in NEUT,PLT,CRP,PCT and Scr. It is crucial to reasonably interpretate this phenomenon to judge whether disease has aggravated or relieved post-intervention. Neutrophils are phagocytes with an essential role in defending the host against invading pathogens, particularly bacteria 【 21 】 . Apart from their essential roles in immune homeostasis, neutrophils are involved in the pathogenesis of sepsis. Most neutrophils are differentiated and resided in the bone marrow before being liberated into the peripheral blood, including the mitotic neutrophil pool, the postmitotic neutrophil pool and the mature neutrophil pool. 【 21 】 Mature neutrophils are present in the vasculature in two pools: a free-flowing intravascular blood pool(circulating pool) and a blood pool residing in certain tissues(marginated pool). It is thought that marginated neutrophils were in complete equilibrium with free-flowing cells under physiologic conditions 【 22 】 However, the homeostasis will be disrupted under acute inflammatory conditions, such as systemic inflammatory response syndrome (SIRS) 【 23 】 . In condition of severe sepsis, proinflammatory cytokines affect the distribution of neutrophils within the vasculature, and an abundance of neutrophils migrate from circulating pool to marginated pool in a dysregulated way. In result, the blood analysis will show lower WBC count than the actual level in peripheral blood. When the source of infection is under control, rebound WBC count caused by the reversed migration will be detected. In present study, we found that preoperative shock was the only independent risk factor for post-operative WBC flare. In addition, NEUT was also found to flare significantly more frequently in patients with septic shock. This phenomenon could be interpreted by “wall attachment effect of neutrophils” in the condition of severe sepsis, and a “fast-bounce” associated with inflammation relief after the drainage of obstruction. We considered the flare of WBC and NEUT as a protective response and a prediction of favorable prognosis. Apart from the flare of WBC and NEUT,it has been demonstrated that PLT, CRP,PCT and Scr were also associated with the occurrence of flare. Our study showed that PLT (61.73%)had the highest probability of flare ,while the proportion of Scr flare(6.17%)was the lowest ,moreover, refractory shock occurred in all 5 patients with Scr flare. We believe that the progressively decreased Scr may be deemed as a suitable biomarker predicting disease remission at an early stage. We have to acknowledge our study had certain limitations. We had taken a retrospectively observational analysis at a single institution, which may have affected the power of the results and resulted in selection bias. In addition, the diagnosis of sepsis was derived from older definitions of sepsis and septic shock, which does not necessarily correspond to the most recent Sepsis-3 definition. Owing to the lower specificity of Sepsis-2 definition for severe urosepsis,a percentage of patients could have a favorable outcome without any drainage, and they may be exposed to the risk of side effects from over-treatment. We used SIRS criteria instead of SOFA criteria in the present study for following reasons: first, the SOFA criteria were not popularized and fully verified in urosepsis at the early period of our recruitment, reclassification of the patients after the enrollment was not feasible. Additionally, while the overall risk of mortality is fairly low in patients with obstructing upper urinary tract stones and urinary tract infection, a delay in decompression increased odds of mortality by 29% 【10】 .Moreover, patients with OUs were usually required emergent decompression under a waking state of consciousness just as mentioned above. Nevertheless, prior study suggested that qSOFA has limited utility in early prognostication in high-mortality populations 【 24 】 ,it is vital to identify these patients at early stage on the basis of SIRS criteria. Last but not least, it has been demonstrated that presence of SIRS in obstructive urolithiasis patients was associated with increased risk for revisits to the emergency department 【 5 】 . A timely renal drainage according to Sepsis-2 definition may contribute to decrease the probability of relapse caused by persistent obstruction. Conclusion The flare of leukocytes is associated with neutrophils migration caused by severe inflammation rather than the result of decompressed procedure or exacerbated retrograde infection. Decreased serum creatinine could be recognized as an ideal predictor for the early detection of remission. Declarations Ethics approval and consent to participate The Ethics Committee of Ruijin Hospital, School of Medicine, Shanghai Jiaotong University approved the study protocol (NO.2022-190). All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Ethics Committee of Ruijin Hospital waived the requirement for informed consent because of the retrospective design of this study. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Competing interests None of the authors have a potential conflict of interest in relation to this article. Funding Not applicable. Author contributions Baoxing Huang concieved the original idea and wrote the manuscript, Guoliang Lu contributed significantly to analysis and manuscript preparation, Weichao Tu performed the analytic calculations. Yuan Shao contributed to the interpretation of the results. Dawei Wang helped supervise the project and collect data. Danfeng Xu contributed to the final version of the manuscript and supervised the project. All authors discussed the results and commented on the manuscript. Acknowledgements Not applicable. References Heyns CF. Urinary tract infection associated with conditions causing urinary tract obstruction and stasis, excluding urolithiasis and neuropathic bladder. World J Urol. 2012;30(1):77–83. Wagenlehner FME, Bjerklund Johansen TE, Cai T, Koves B, Kranz J, Pilatz A, et al. Epidemiology, definition and treatment of complicated urinary tract infections. Nature reviews Urology. 2020;17(10):586–600. Borofsky MS, Walter D, Shah O, Goldfarb DS, Mues AC, Makarov DV. 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Tables Table 1 Univariate analysis of variable associated with the flare of leukocytes after drainage of obstruction in patients with obstructive urosepsis Variable Overall(n) Flare group(n = 43) Non-flare group(n = 38) P value OR 95%CI Age, year x̄ ± s 66.05 ± 13.05 62.34 ± 12.77 0.202 Age ≥ 60 n(%) 50 29(67.38) 21(55.26) 0.26 1.677 0.68–4.138 Gender, n(%) 0.273 1.782 0.630–5.042 Male 19 8(18.60) 11(28.95) Female 62 35(81.40) 27(71.05) CCI,score x̄ ± s 3.74 ± 2.21 2.74 ± 1.84 0.03 Immunodeficiency, n(%) 5(11.63) 1(2.63) 0.123 4.868 0.543–43.685 Diabetes mellitus, ,n(%) 32 18(41.86) 14(36.84) 0.645 1.234 0.504–3.022 Disabled, n(%) 27 16(37.21) 11(28.95) 0.091 2.310 0.868–6.146 Fever, n(%) 60 32(74.42) 28(73.68) 0.940 1.039 0.384–2.811 Side, n(%) 0.895 1.529 0.633–3.695 Left 45 26(60.47) 19(50) Right 36 17(39.53) 19(50) UTI, n(%) 63 35(58.14) 28(73.68) 0.405 1.563 0.545–4.484 Positive urine culture, n(%) 49 27(36.99) 22(57.89) 0.653 1.227 0.503–2.997 Decompressed manner 0.694 1.563 0.545–4.484 RUS, n(%) 63 35(81.40) 28(73.68) PCN, n(%) 18 8(18.60) 10(26.32) Shock, n(%) 33 27(62.79) 6(15.79) 0.001 9.00 3.09-26.211 WBC count(*10^9/l) 15.29 ± 8.68 17.64 ± 8.33 0.255 NEUT%, n(%) 92.08 ± 4.15 88.99 ± 5.34 0.005 NEUT＞90, n(%) 54 35(81.40) 19(50) 0.003 4.375 1.614–11.859 PLT, x̄±s 110.26 ± 61.80 160.61 ± 88.27 0.005 PLT＜101*10^9/L 32 19(44.19) 13(34.21) 0.359 1.522 0.618–3.747 CRP(mg/L), x̄±s 156.38 ± 79.78 132.60 ± 81.01 0.188 PCT(ng/ml), x̄±s 55.78 ± 33.60 31.08 ± 29.97 0.001 Prolonged CT, n(%) 23 15(34.88) 8(21.05) 0.168 2.009 0.738–5.465 28-day mortality 1 1(2.33) 0 Table 2 Multivariate analysis of variable associated with flare of leukocytes after drainage of obstruction in patients with obstructive urosepsis P value OR 95%CI CCI 0.055 1.285 0.995–1.660 Shock 0.001 9.116 3.028–27.438 Table 3 The univariate analysis of flare after drainage of obstruction in WBC,NEUT,PLT,Scr,CRP and PCT Variable (n = 81) Flare group P value * Flare group with shock Non-Flare with shock χ 2 P value OR 95%CI WBC, n(%) 43(53.09) 27(62.79) 6(15.79) 18.459 ＜0.001 9.00 3.09-26.211 NEUT, n(%) 21(25.93) 0.001 15(71.43) 17(28.33) 12.088 0.001 6.324 2.103–19.011 PLT, n(%) 50(61.73) 0.266 23(46) 10(32.26) 1.497 0.221 1.789 0.701–4.562 Scr, n(%) 5(6.17) 0.001 5(100) 28(36.84) 0.009 2.714 2.022–3.643 CRP, n(%) 33(40.74) 0.115 16(48.48) 17(35.42) 1.383 0.24 1.716 0.695–4.235 PCT, n(%) 18(22.22) 0.001 8(44.44) 25(39.68) 0.131 0.717 1.216 0.422–3.502 *Compared with WBC Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1940385","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":130821805,"identity":"13401d54-4a67-4ebd-8687-ddef660f31c2","order_by":0,"name":"Baoxing Huang","email":"","orcid":"","institution":"Ruijin Hospital,Shanghai JiaoTong University School of Medicine,Shanghai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Baoxing","middleName":"","lastName":"Huang","suffix":""},{"id":130821807,"identity":"5a671e3a-95a5-4c2f-a641-a811662182ff","order_by":1,"name":"Guoliang Lu","email":"","orcid":"","institution":"Ruijin Hospital,Shanghai JiaoTong University School of Medicine,Shanghai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Guoliang","middleName":"","lastName":"Lu","suffix":""},{"id":130821809,"identity":"2eb1d9a1-e913-44b6-ac54-4e59af964003","order_by":2,"name":"Weichao Tu","email":"","orcid":"","institution":"Ruijin Hospital,Shanghai JiaoTong University School of Medicine,Shanghai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Weichao","middleName":"","lastName":"Tu","suffix":""},{"id":130821810,"identity":"3713838b-18fe-426c-9b45-964a10cad871","order_by":3,"name":"Yuan Shao","email":"","orcid":"","institution":"Ruijin Hospital,Shanghai JiaoTong University School of Medicine,Shanghai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Shao","suffix":""},{"id":130821812,"identity":"8722a47d-fd8c-46db-8cf9-4874f1c05128","order_by":4,"name":"Dawei Wang","email":"","orcid":"","institution":"Ruijin Hospital,Shanghai JiaoTong University School of Medicine,Shanghai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dawei","middleName":"","lastName":"Wang","suffix":""},{"id":130821814,"identity":"3c582eed-0afe-4fad-8be2-58f636cd46de","order_by":5,"name":"Danfeng Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYFCCxAcHPhjUyPEzMKQRqyXZ8OCMimPGkg0kaDE+zHOGOdHgAAMbcRoMjiczHOBtY0swvn3g2QOGGptoBvazB/Bqkex5zHBAsk0mz+xcQroBw7G03AaevAS8Wvgl8g8cMGxjKzY7w5AmwdhwOLdBgscArxY2CaDDEtuYEzf3EKuFH6TlAND7G3iI1QLyy8EGYCBLgByWAPRLG08Ofi3AEGP+/AcUlT08aRIfamxy+9nP4NeCBHgSGBJAviNWPRCwHyBB8SgYBaNgFIwkAACxGEYW4G6obgAAAABJRU5ErkJggg==","orcid":"","institution":"Ruijin Hospital,Shanghai JiaoTong University School of Medicine,Shanghai","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Danfeng","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2022-08-08 08:44:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1940385/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1940385/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":25669824,"identity":"0f7fa98f-65ad-4510-96c6-700f2ac07873","added_by":"auto","created_at":"2022-08-25 17:08:19","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28115,"visible":true,"origin":"","legend":"\u003cp\u003eROC analysis demonstrating the sensitivity and specificity of CCI ,shock and PRE in prediction of flare of leukocytes after drainage of obstruction in patients with obstructive urosepsis ( for CCI AUC= 0.638, 95%CI 0.517-0.759，P=0.033;forshock AUC= 0.735，95%CI 0.624-0.846，P＜0.001;for PRE AUC= 0.796，95%CI 0.699-0.893，P＜0.001)\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1940385/v1/b0678961d68ea3c073c96851.jpg"},{"id":39999625,"identity":"af087771-203e-47c1-8e1c-0176bdbff1ae","added_by":"auto","created_at":"2023-07-13 18:44:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":381685,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1940385/v1/393ed2ba-48c7-4a36-90f9-1e57f8f31be3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors influencing the flare of inflammatory markers after drainage of obstruction for patients with obstructive urosepsis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObstructive urosepsis(OUs) is a severe septic pathology that can potentially lead to death, the most common obstructive factor is ureteral stone, other rare risk factors including urethral stricture, ureteral tumors et.al\u003csup\u003e【\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e】\u003c/sup\u003e. Prompt renal decompression and antibiotics are considered as the gold standard in the treatment of OUs\u003csup\u003e【\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e】\u003c/sup\u003e. Meanwhile, we require objective biomarkers to serve as indicators of response to the therapeutic intervention. A large armamentarium of serum sepsis biomarkers has been reported over the past years\u003csup\u003e【\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e】\u003c/sup\u003e, however, a majority of tests are experimental, costly and not commonly available in the emergent department in a timely manner\u003csup\u003e【\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e】\u003c/sup\u003e. Leukocytosis still plays a vital role in predicting the risk of sepsis and triggering surgical decompression of OUs\u003csup\u003e【\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e】\u003c/sup\u003e. In addition, urologists usually determine the therapeutic outcome based on the dynamic change of leukocyte counts(WBC). In clinical practice, we observed distinct changes of WBC count among different patients in the perioperative period. Herein, the primary aim of the present study was to analyze the risk factors which cause the flare of WBC count after obstructive decompression. The secondary aim was to evaluate the objective biomarker predicting early remission of OUs.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e\u003cstrong\u003eData source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective observational single-center study was performed in the Department of urology of the Ruijin Hospital ,Shanghai Jiaotong University School of Medicine, Shanghai, China. The study was approved by the local ethics committee and the requirement for informed consent was waived due to the retrospective study design.Data were collected in the period between February 2017 and January 2022. All patients were diagnosed with urosepsis based on the criteria of Sepsis 2\u003csup\u003e【\u003c/sup\u003e\u003csup\u003e7\u003c/sup\u003e\u003csup\u003e】\u003c/sup\u003e and were categorized into two groups according to whether inflammatory markers flare or not after relief of obstruction.\u003c/p\u003e\n\u003cp\u003ePatients were only included if they underwent decompression with percutaneous nephrostomy(PCN)or retrograde ureteric stent(RUS) for concern of infection combined with obstructive urolithiasis. This was determined based on review of clinical documentation and procedure indications. Patients undergoing urinary decompression for other indications (e.g. tumor compression ,acute kidney injury, etc.), as well as suffered from hematologic diseases or concomitant infection in other organs were excluded. Patients who did not undergo decompression or received one-stage holmium laser lithotripsy, and patients with missing data were also excluded from the analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnosis and management of OUs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe diagnosis of OUs was determined clinically in accordance with the sepsis criteria. All patients enrolled in the study were received urgent PCN or RUS under local anesthesia. A urine sample was taken from the obstructed kidney. Meanwhile, intravenous antibiotics by carbapenems were treated initially upon their admission to the emergency department. All patients underwent laboratory investigations including routine blood test, C-reactive protein, procalcitonin, renal function, liver function, blood electrolyte, coagulative function on the day prior to surgery and on the first postoperative day respectively. Urine test and urine cultures were also assessed before the decompression. Prolonged coagulating time(CT) was defined as APTT＞39.5s or PT＞15s.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescription of inflammatory markers flare\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFlare of inflammatory markers was defined as rising WBC count, percentage of neutrophils（NEUT%）, C-reactive protein（CRP）,procalcitonin(PCT),serum creatinine(Scr) or decreased platelet count(PLT) on the 1\u003csup\u003est\u003c/sup\u003e day postoperatively compared with its level on the day received decompression. Patients were also included into the flare group for those CRP or PCT consecutively demonstrating out of measure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS19.0 statistical software was used for data analysis. Continuous data were expressed as mean \u0026plusmn; SD. Univariate analysis of predictors of flare was done using Pearson chi-square test, Student\u0026apos;s sample t-test or Mann Whitney U test as appropriate. The P value and relative ratio were calculated for risk factors. Multivariate analysis was done using logistic regression analysis. The discriminatory power of risk factors was determined by the area under the receiver operating characteristic curve (ROC) with corresponding 95% CIs. P\u0026lt; 0.05 was defined as a statistically significant difference.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics and outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included 81 patients with OUs. In total,63(77.77%) were admitted for decompression with RUS，and18 (22.22%)patients underwent drainage of PCN. The baseline characteristics, laboratory data and prognosis of patients are summarized in Table 1. There was no significant difference in age, sex, diabetes mellitus ,fever, stone side, positive UTI, positive urine culture and decompressed manner between WBC flare group and non-flare group(P \u0026gt; 0.05; Table 1) .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnivariable and multivariable associations with leukocytes flare\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our cohort, WBC count levels, CRP levels and prolonged coagulating time show no correlation with leukocytes flare in univariate analysis(P＞0.05). In the further univariate logistic regression analysis，pre-operative shock (OR=9.00,95%CI=3.09-26.211, P＜0.001）, NEUT＞90%（(OR=4.375,95%CI=1.614-26.11.859, P＝0.003）, decreased PLT(110.26\u0026plusmn;61.80vs 160.61\u0026plusmn;88.2, P＜0.001), elevated CCI scores（3.74\u0026plusmn;2.21vs2.74\u0026plusmn;1.84, P=0.03）,NEUT （92.08\u0026plusmn;4.15vs88.99\u0026plusmn;5.34, P=0.005）and procalcitonin（55.78\u0026plusmn;33.60vs31.08\u0026plusmn;29.97, P＜0.001） were found to be significantly associated with the occurrence of leukocytes flare (Table 1).\u003c/p\u003e\n\u003cp\u003eOn forward stepwise multivariable logistic regression, preoperative shock was the only independent risk factor for leukocytes flare（OR=9.116,95%CI=3.028-27.438, P＜0.001）(Table 2). The AUC for the multivariate regression model (Predicted Probability, PRE)was 0.796，95%CI 0.699-0.893, P＜0.001(Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe analysis of flare in other inflammatory markers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith respect to the flare of other inflammation-associated markers, analysis revealed that the risk of flare varied greatly, with flares being most common in PLT（61.73%）, and being rarest in Scr(6.17%) (Table 3).\u003c/p\u003e\n\u003cp\u003eRelationship between the flare of WBC, NEUT, PLT, CRP, PCT, Scr and shock was analyzed in the univariate analysis. Patients with shock were found to flare significantly more frequently when compared to those without shock in NEUT （OR=6.324,95%CI=2.103-19.011, P＝0.001）and Scr（OR=2.714,95%CI=2.022-3.643, P＝0.009）. Our study did not show any correlation between shock and flare of PLT,CRP or PCT(P＞0.05)(Table 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eObstructive urosepsis is a life-threatening organ dysfunction caused by an overwhelming host immune response associated with organic or functional urinary tract abnormalities such as urinary stones, stenosis or tumors\u003csup\u003e【\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e】\u003c/sup\u003e .It can cause severe conditions such as septic shock and disseminated intravascular coagulopathy (DIC)\u003csup\u003e【\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e】\u003c/sup\u003e. It is accepted that urgent drainage of the obstructed system with retrograde ureteric stent (RUS)or percutaneous nephrostomy ༈PCN༉ can reduce intrarenal pressure and improve prognosis\u003csup\u003e【\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e】\u003c/sup\u003e. With respect to the technique of surgical decompression, it has always been in active debate\u003csup\u003e【\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e】\u003c/sup\u003e. Several results demonstrated that PCN is superior to RUS for emergent drainage of OUs. One area of theoretical concern is the risk of instrumentation and worsening urosepsis when performing retrograde stenting\u003csup\u003e【\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e】\u003c/sup\u003e.However, to date, the literature does not support this hypothesis and most studies failed to confirm the superiority and inferiority between these two techniques \u003csup\u003e【\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e】\u003c/sup\u003e. Similarly, our present study could not show different clinical outcome between the technique of RUS and PCN. It is noteworthy that emergent drainage may inevitably cause aggravating bacteremia temporarily under certain conditions. Nevertheless, both PCN and RUS could trigger the transient fluctuation equally\u003csup\u003e【\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e】\u003c/sup\u003e and bacteremia will be eliminated timely under synchronous protection of effective antibiotics.\u003c/p\u003e \u003cp\u003eOne another superiority of PCN over RUS ,it is deemed that the former procedure could be undertaken with local anaesthesia only, whereas the latter one was usually performed under general anaesthesia,\u003csup\u003e【\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e】\u003c/sup\u003e. Therefore, the application of RUS may be restricted to patients with severe or refractory septic shock who have contraindication under general anaesthesia. In the present study, we performed all RUS under local anaesthesia, no operative interruption or accident was recorded, we considered RUS under local anaesthesia has satisfactory safety and tolerance. However, it is important to note that all these patients should be guaranteed under conscious state and possess the ability of following instructions. To detect patients required prompt decompression earlier, we included patients with OUs based on the criteria of systemic inflammatory response syndrome (SIRS) not qSOFA.\u003c/p\u003e \u003cp\u003eMeasuring routine blood count is a convenient and quickly approach which contribute to reflect the systemic inflammatory response to infection and evaluate the therapeutic efficiency\u003csup\u003e【\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e】\u003c/sup\u003e. Leukocytosis (more than 12.0 *10\u003csup\u003e9\u003c/sup\u003e /L) or leukopenia (lower 4.0 *10\u003csup\u003e9\u003c/sup\u003e /L) has been included in the diagnostic criteria of SIRS \u003csup\u003e【\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e】\u003c/sup\u003e. Similarly, NEUT% and PLT count were also demonstrated as biomarkers evaluating the severity of infection. Prior study showed that decreases in the platelet count were independent risk factors for septic shock\u003csup\u003e【\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e】\u003c/sup\u003e. Additionally, lower platelet to leucocytic count ratio (PLR) was considered as an independent simple predictor for sepsis and mortality in patients with sepsis or emphysematous pyelonephritis\u003csup\u003e【\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e】\u003c/sup\u003e.Nevertheless ,it is notable that even in bacteremic patients with hypotension or septic shock, 21% had a normal WBC count on initial evaluation, suggesting that these parameters are relatively insensitive even in the case of severe physiologic derangement\u003csup\u003e【\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e】\u003c/sup\u003e. On the contrary, some patients without infection may present high blood leukocyte counts in the proper clinical scenario, such as simple renal colic. Although its limitation in insufficient sensitivity and specificity, WBC count play a vital and fundamental role in evaluate the severity and the disease course of sepsis\u003csup\u003e【\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e】\u003c/sup\u003e. Furthermore, the dynamic change of WBC before and after drainage was always clinically applied as a predictive marker in determining the therapeutic effects for patients with OUs. In theory, eliminating the influencing effect of surgical procedure, WBC counts should be totally decreased progressively after the decompression of OUs. However, our data demonstrated distinct variation in WBC around the drainage, a cohort of patients manifest WBC flare though with elevated or normal value on the day of procedure, while other patients show progressive decrease. Similar flare of other biomarkers related to sepsis was also identified in NEUT,PLT,CRP,PCT and Scr. It is crucial to reasonably interpretate this phenomenon to judge whether disease has aggravated or relieved post-intervention.\u003c/p\u003e \u003cp\u003eNeutrophils are phagocytes with an essential role in defending the host against invading pathogens, particularly bacteria\u003csup\u003e【\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e】\u003c/sup\u003e. Apart from their essential roles in immune homeostasis, neutrophils are involved in the pathogenesis of sepsis. Most neutrophils are differentiated and resided in the bone marrow before being liberated into the peripheral blood, including the mitotic neutrophil pool, the postmitotic neutrophil pool and the mature neutrophil pool.\u003csup\u003e【\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e】\u003c/sup\u003eMature neutrophils are present in the vasculature in two pools: a free-flowing intravascular blood pool(circulating pool) and a blood pool residing in certain tissues(marginated pool). It is thought that marginated neutrophils were in complete equilibrium with free-flowing cells under physiologic conditions\u003csup\u003e【\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e】\u003c/sup\u003eHowever, the homeostasis will be disrupted under acute inflammatory conditions, such as systemic inflammatory response syndrome (SIRS)\u003csup\u003e【\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e】\u003c/sup\u003e. In condition of severe sepsis, proinflammatory cytokines affect the distribution of neutrophils within the vasculature, and an abundance of neutrophils migrate from circulating pool to marginated pool in a dysregulated way. In result, the blood analysis will show lower WBC count than the actual level in peripheral blood. When the source of infection is under control, rebound WBC count caused by the reversed migration will be detected.\u003c/p\u003e \u003cp\u003eIn present study, we found that preoperative shock was the only independent risk factor for post-operative WBC flare. In addition, NEUT was also found to flare significantly more frequently in patients with septic shock. This phenomenon could be interpreted by \u0026ldquo;wall attachment effect of neutrophils\u0026rdquo; in the condition of severe sepsis, and a \u0026ldquo;fast-bounce\u0026rdquo; associated with inflammation relief after the drainage of obstruction. We considered the flare of WBC and NEUT as a protective response and a prediction of favorable prognosis.\u003c/p\u003e \u003cp\u003eApart from the flare of WBC and NEUT,it has been demonstrated that PLT, CRP,PCT and Scr were also associated with the occurrence of flare. Our study showed that PLT (61.73%)had the highest probability of flare ,while the proportion of Scr flare(6.17%)was the lowest ,moreover, refractory shock occurred in all 5 patients with Scr flare. We believe that the progressively decreased Scr may be deemed as a suitable biomarker predicting disease remission at an early stage.\u003c/p\u003e \u003cp\u003eWe have to acknowledge our study had certain limitations. We had taken a retrospectively observational analysis at a single institution, which may have affected the power of the results and resulted in selection bias. In addition, the diagnosis of sepsis was derived from older definitions of sepsis and septic shock, which does not necessarily correspond to the most recent Sepsis-3 definition. Owing to the lower specificity of Sepsis-2 definition for severe urosepsis,a percentage of patients could have a favorable outcome without any drainage, and they may be exposed to the risk of side effects from over-treatment. We used SIRS criteria instead of SOFA criteria in the present study for following reasons: first, the SOFA criteria were not popularized and fully verified in urosepsis at the early period of our recruitment, reclassification of the patients after the enrollment was not feasible. Additionally, while the overall risk of mortality is fairly low in patients with obstructing upper urinary tract stones and urinary tract infection, a delay in decompression increased odds of mortality by 29%\u003csup\u003e【10】\u003c/sup\u003e.Moreover, patients with OUs were usually required emergent decompression under a waking state of consciousness just as mentioned above. Nevertheless, prior study suggested that qSOFA has limited utility in early prognostication in high-mortality populations\u003csup\u003e【\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e】\u003c/sup\u003e,it is vital to identify these patients at early stage on the basis of SIRS criteria.\u003c/p\u003e \u003cp\u003eLast but not least, it has been demonstrated that presence of SIRS in obstructive urolithiasis patients was associated with increased risk for revisits to the emergency department\u003csup\u003e【\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e】\u003c/sup\u003e. A timely renal drainage according to Sepsis-2 definition may contribute to decrease the probability of relapse caused by persistent obstruction.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe flare of leukocytes is associated with neutrophils migration caused by severe inflammation rather than the result of decompressed procedure or exacerbated retrograde infection. Decreased serum creatinine could be recognized as an ideal predictor for the early detection of remission.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of Ruijin Hospital, School of Medicine, Shanghai Jiaotong University approved the study protocol (NO.2022-190). All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of Ruijin Hospital waived the requirement for informed consent because of the retrospective design of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the\u003cbr\u003ecorresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors have a potential conflict of interest in relation to this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBaoxing Huang concieved the original idea and wrote the manuscript, Guoliang Lu contributed significantly to analysis and manuscript preparation, Weichao Tu performed the analytic calculations. Yuan Shao contributed to the interpretation of the results. Dawei Wang helped supervise the project and collect data. Danfeng Xu contributed to the final version of the manuscript and supervised the project. All authors discussed the results and commented on the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHeyns CF. Urinary tract infection associated with conditions causing urinary tract obstruction and stasis, excluding urolithiasis and neuropathic bladder. World J Urol. 2012;30(1):77\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWagenlehner FME, Bjerklund Johansen TE, Cai T, Koves B, Kranz J, Pilatz A, et al. Epidemiology, definition and treatment of complicated urinary tract infections. Nature reviews Urology. 2020;17(10):586\u0026ndash;600.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorofsky MS, Walter D, Shah O, Goldfarb DS, Mues AC, Makarov DV. Surgical decompression is associated with decreased mortality in patients with sepsis and ureteral calculi. The Journal of urology. 2013;189(3):946\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLippi G. Sepsis biomarkers: past, present and future. Clinical chemistry and laboratory medicine. 2019;57(9):1281\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLarkin S, Johnson J, Venkatesh T, Vetter J, Venkatesh R. 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. BMC urology. 2020;20(1):77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSrougi V, Moscardi PR, Marchini GS, Berjeaut RH, Torricelli FC, Mesquita JLB, et al. Septic Shock Following Surgical Decompression of Obstructing Ureteral Stones: A Prospective Analysis. Journal of endourology. 2018;32(5):446\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165\u0026ndash;228.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinger M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIba T, Levy JH. Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation. Anesthesiology. 2020;132(5):1238\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaas CR, Li G, Hyams ES, Shah O. Delayed Decompression of Obstructing Stones with Urinary Tract Infection is Associated with Increased Odds of Death. The Journal of urology. 2020;204(6):1256\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamasuna R, Takahashi S, Nagae H, Kubo T, Yamamoto S, Arakawa S, et al. Obstructive pyelonephritis as a result of urolithiasis in Japan: diagnosis, treatment and prognosis. International journal of urology: official journal of the Japanese Urological Association. 2015;22(3):294\u0026ndash;300.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu ZH, Yang YH, Zhou S, Lv JL. Percutaneous nephrostomy versus retrograde ureteral stent for acute upper urinary tract obstruction with urosepsis. Journal of infection and chemotherapy: official journal of the Japan Society of Chemotherapy. 2021;27(2):323\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMokhmalji H, Braun PM, Martinez Portillo FJ, Siegsmund M, Alken P, Kohrmann KU. Percutaneous nephrostomy versus ureteral stents for diversion of hydronephrosis caused by stones: a prospective, randomized clinical trial. The Journal of urology. 2001;165(4):1088\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlukes S, Hayne D, Kuan M, Wallace M, McMillan K, Rukin NJ. Retrograde ureteric stent insertion in the management of infected obstructed kidneys. BJU international. 2015;115 Suppl 5:31\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMosli HA, Farsi HM, al-Zimaity MF, Saleh TR, al-Zamzami MM. Vesicoureteral reflux in patients with double pigtail stents. The Journal of urology. 1991;146(4):966\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNevo A, Mano R, Baniel J, Lifshitz DA. Ureteric stent dwelling time: a risk factor for post-ureteroscopy sepsis. BJU international. 2017;120(1):117\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTambo M, Okegawa T, Shishido T, Higashihara E, Nutahara K. Predictors of septic shock in obstructive acute pyelonephritis. World J Urol. 2014;32(3):803\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElbaset MA, Zahran MH, Hashem A, Ghobrial FK, Elrefaie E, Badawy M, et al. Could platelet to leucocytic count ratio (PLR) predict sepsis and clinical outcomes in patients with emphysematous pyelonephritis? Journal of infection and chemotherapy: official journal of the Japan Society of Chemotherapy. 2019;25(10):791\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGao L, Shi Q, Li H, Guo Q, Yan J, Zhou L. Prognostic value of the combined variability of mean platelet volume and neutrophil percentage for short-term clinical outcomes of sepsis patients. Postgraduate medicine. 2021;133(6):604\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeigel TA, Cocchi MN, Salciccioli J, Shapiro NI, Howell M, Tang A, et al. Inadequacy of temperature and white blood cell count in predicting bacteremia in patients with suspected infection. The Journal of emergency medicine. 2012;42(3):254\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHidalgo A, Chilvers ER, Summers C, Koenderman L. The Neutrophil Life Cycle. Trends in immunology. 2019;40(7):584\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAthens JW, Haab OP, Raab SO, Mauer AM, Ashenbrucker H, Cartwright GE, et al. Leukokinetic studies. IV. The total blood, circulating and marginal granulocyte pools and the granulocyte turnover rate in normal subjects. The Journal of clinical investigation. 1961;40:989\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeliefeld PH, Wessels CM, Leenen LP, Koenderman L, Pillay J. The role of neutrophils in immune dysfunction during severe inflammation. Critical care. 2016;20:73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimpson SQ. New Sepsis Criteria: A Change We Should Not Make. Chest. 2016;149(5):1117\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eUnivariate analysis of variable associated with the flare of leukocytes after drainage of obstruction in patients with obstructive urosepsis\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOverall(n)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFlare group(n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNon-flare group(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge, year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ex̄ \u0026plusmn; s\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66.05\u0026thinsp;\u0026plusmn;\u0026thinsp;13.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62.34\u0026thinsp;\u0026plusmn;\u0026thinsp;12.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.202\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;60 n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29(67.38)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21(55.26)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.677\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.68\u0026ndash;4.138\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.273\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.782\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.630\u0026ndash;5.042\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(18.60)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(28.95)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35(81.40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27(71.05)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCCI,score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ex̄ \u0026plusmn; s\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eImmunodeficiency, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(11.63)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(2.63)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.123\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.868\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.543\u0026ndash;43.685\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiabetes mellitus, ,n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(41.86)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(36.84)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.645\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.234\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.504\u0026ndash;3.022\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDisabled, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16(37.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(28.95)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.091\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.310\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.868\u0026ndash;6.146\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFever, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32(74.42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(73.68)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.940\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.039\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.384\u0026ndash;2.811\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSide, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.895\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.529\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.633\u0026ndash;3.695\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLeft\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26(60.47)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19(50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(39.53)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19(50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUTI, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35(58.14)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(73.68)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.405\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.563\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.545\u0026ndash;4.484\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePositive urine culture, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27(36.99)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22(57.89)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.653\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.227\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.503\u0026ndash;2.997\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDecompressed manner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.694\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.563\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.545\u0026ndash;4.484\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRUS, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35(81.40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(73.68)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCN, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(18.60)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(26.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShock, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27(62.79)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(15.79)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.09-26.211\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWBC count(*10^9/l)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.29\u0026thinsp;\u0026plusmn;\u0026thinsp;8.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.64\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.255\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNEUT%, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e92.08\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e88.99\u0026thinsp;\u0026plusmn;\u0026thinsp;5.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNEUT＞90, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35(81.40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19(50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.375\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.614\u0026ndash;11.859\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePLT, x̄\u0026plusmn;s\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110.26\u0026thinsp;\u0026plusmn;\u0026thinsp;61.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e160.61\u0026thinsp;\u0026plusmn;\u0026thinsp;88.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePLT＜101*10^9/L\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19(44.19)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(34.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.359\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.522\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.618\u0026ndash;3.747\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCRP(mg/L), x̄\u0026plusmn;s\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e156.38\u0026thinsp;\u0026plusmn;\u0026thinsp;79.78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e132.60\u0026thinsp;\u0026plusmn;\u0026thinsp;81.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.188\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT(ng/ml), x̄\u0026plusmn;s\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.78\u0026thinsp;\u0026plusmn;\u0026thinsp;33.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.08\u0026thinsp;\u0026plusmn;\u0026thinsp;29.97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProlonged CT, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15(34.88)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(21.05)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.168\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.738\u0026ndash;5.465\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28-day mortality\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(2.33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultivariate analysis of variable associated with flare of leukocytes after drainage of obstruction in patients with obstructive urosepsis\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCCI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.055\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.285\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.995\u0026ndash;1.660\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShock\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.116\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.028\u0026ndash;27.438\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThe univariate analysis of flare after drainage of obstruction in WBC,NEUT,PLT,Scr,CRP and PCT\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFlare group\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFlare group with shock\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNon-Flare with shock\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026chi;\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWBC, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43(53.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27(62.79)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(15.79)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.459\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e＜0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.09-26.211\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNEUT, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21(25.93)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15(71.43)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(28.33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.088\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.324\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.103\u0026ndash;19.011\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePLT, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50(61.73)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.266\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23(46)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(32.26)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.497\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.221\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.789\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.701\u0026ndash;4.562\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eScr, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(6.17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(36.84)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.714\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.022\u0026ndash;3.643\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCRP, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33(40.74)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.115\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16(48.48)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(35.42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.383\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.716\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.695\u0026ndash;4.235\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT, n(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(22.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(44.44)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25(39.68)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.717\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.216\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.422\u0026ndash;3.502\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"9\"\u003e*Compared with WBC\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acute upper urinary tract obstruction, Emergent drainage, Urosepsis, Leukocytes, Serum creatinine","lastPublishedDoi":"10.21203/rs.3.rs-1940385/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1940385/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To analyze risk factors associated with the flare of inflammatory markers after drainage of obstruction for patients with obstructive urosepsis(OUs) and evaluate the laboratory tests for early judgement of patients’ outcome.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e We conducted a retrospective study including patients with OUs who received surgical decompression of obstruction in our center between February 2017and January 2022.All patients were categorized into two groups based on whether inflammatory markers flare or not after relief of obstruction. Analysis of patients’ characteristics, manner of decompression and laboratory tests were performed. \u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e A total of 81 patients were enrolled in this study and we identified 43 cases(53.9%) with serum leukocytes flare. The only risk factor for the flare of serum leukocytes in multivariate analyses was shock（OR=9.116,95%CI=3.028-27.438,P＜0.001）. The receiver operating characteristic\u0026nbsp;curve of multivariate model showed an area of 0.796，95%CI 0.699-0.893,P＜0.001. Patients with shock were found to\u0026nbsp;flare\u0026nbsp;significantly more frequently when compared to those without shock for neutrophil (NEUT)（OR=6.324,95%CI=2.103-19.011,P＝0.001）and serum creatinine(Scr)（OR=2.714,95%CI=2.022-3.643,P＝0.009. Outcome analysis suggested that decreased Scr acted as a leading indicator for the early remission of sepsis（n=76，93.8%）.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e The flare of leukocytes after drainage of obstruction may reflect the dysregulated migration of neutrophils caused by severe urosepsis rather than the results of decompressed procedure or exacerbated retrograde infection. Decreased serum creatinine may serve as an ideal predictor for the early detection of remission.\u003c/p\u003e","manuscriptTitle":"Factors influencing the flare of inflammatory markers after drainage of obstruction for patients with obstructive urosepsis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-08-25 17:08:17","doi":"10.21203/rs.3.rs-1940385/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0cfdd55f-a83a-48c0-b9f1-3a58e0f6f331","owner":[],"postedDate":"August 25th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-07-13T18:44:10+00:00","versionOfRecord":[],"versionCreatedAt":"2022-08-25 17:08:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1940385","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1940385","identity":"rs-1940385","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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