Risk factors of septic shock in bacteremic acute pyelonephritis patients admitted to an ER.

Our objective was to identify factors associated with septic shock in patients with bacteremic acute pyelonephritis who were admitted to our emergency department (ER). We performed a retrospective cohort study of 208 adult cases compiled between January 2000 and December 2010. The mean age of the 208 predominantly female (81.3%) adult cases enrolled during the study period was 65.9 ± 15.2 years. The overall mortality rate was 6.7% (14/208), but the mortality rate of 54 patients (26%, 54/208) who initially presented with shock was 25.9% (14/54). Multiple logistic regression analyses revealed that the independent risk factors for the occurrence of septic shock were the presence of a urinary tract obstruction (OR 4.391, 95% CI 1.782-10.821, P = 0.001), healthcare-associated infection (OR 3.491, 95% CI 1.585-7.692, P = 0.002), and liver cirrhosis (OR 4.609, 95% CI 1.395-15.222, P = 0.012). Therefore, physicians should be aware that appropriate early management is necessary to prevent fatal outcomes in patients with risk factors of septic shock.