RESUMO
INTRODUCTION AND OBJECTIVES: Emphysematous pyelonephritis is a life-threatening infection of the kidney and surrounding tissues associated with a high mortality rate. The aim of this study was to determine predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis, and to propose a therapeutic algorithm based on current literature and our experience. METHODS: A retrospective study was done including patients with emphysematous pyelonephritis in a single center in the north of Mexico from 2011 to 2016. Demographic, clinical, microbiological and biochemical parameters, therapeutic management, and outcomes were assessed. Factors associated with admission to intensive care unit and mortality were determined. Comparison was assessed using X2 test for categorical variables, and T-test for numerical variables. Univariate and multivariate logistic regression analyses were performed. Statistical significance was set at Pâ¯<â¯.05. RESULTS: A total of 63 patients were included, of which 55 (87.3%) were females, with a mean age of 55.5⯱â¯12.2 years. The most common comorbidities were diabetes and hypertension. Escherichia coli was the most common isolated microorganism (51.7%) and extended-spectrum beta-lactamase-producing agents were reported in 31.7%. Conservative therapy was provided to 38.7%, double J stent 42.9%, open/percutaneous drainage 12.7%, and nephrectomy 25.3%. Overall mortality and intensive care admission were 20.6% and 36.5%, respectively. In the multivariate analysis, hemodynamic instability (Pâ¯=â¯.005), qSOFAâ¯≥â¯2 (Pâ¯=â¯.003), hypoalbuminemia (Pâ¯=â¯.02), and early nephrectomy (Pâ¯=â¯.002) were associated with intensive care admission. Huang scale 4 (Pâ¯=â¯.006) and early nephrectomy (Pâ¯=â¯.001) were associated to mortality. CONCLUSIONS: Emphysematous pyelonephritis is a life-threatening disease and evidence of management is based in small case series due to the low incidence of this condition. Hemodynamic instability, hypoalbuminemia, qSOFAâ¯≥â¯2, Huang scale ≥3, and early nephrectomy are associated with poor prognosis.
Assuntos
Enfisema , Hipoalbuminemia , Pielonefrite , Adulto , Idoso , Enfisema/epidemiologia , Enfisema/etiologia , Enfisema/terapia , Feminino , Humanos , Hipoalbuminemia/complicações , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pielonefrite/epidemiologia , Pielonefrite/terapia , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
OBJECTIVE: To evaluate the effect of body mass index (BMI) on PSA in northeast Mexican patients included in prostate cancer (Pca) early detection screening campaigns offered by our institution. MATERIAL AND METHODS: One hundred and ninety seven patients came voluntarily to our Pca early detection screening campaigns. EXCLUSION CRITERIA: PSA >10 ng/dl, patients on 5-α Reductase inhibitors or hormonal replacement. Overweight and obesity were considered when BMI was between 25-29.9 and ≥30 kg/m(2) respectively. Simple linear and multiple regression were used in the statistical analysis. Mean and standard deviation were utilized to evaluate spread and normal distribution. P values <0.05 were considered statistically significant. RESULTS: One hundred and fifty two patients were included in this study. Forty four percent (83) and 30.3%(46) presented with overweight and obesity, respectively. Mean BMI was 28.16 kg/m(2) (SD 1.77). A statistically significant negative effect of BMI on PSA was observed in the linear regression. This effect persisted when adjusted for age in the multiple regression model. A decrease of 0.085 ng/dl for every unit of BMI (p <0.001) was observed in the simple linear regression. This value was 0.07 in the multiple regression (p=0.006) CONCLUSIONS: A higher negative effect of BMI on PSA was found in comparison to published literature. A higher proportion of patients with BMI >25 kg/m(2) than the national mean was observed. A multicentric national study is needed in order to challenge these results.