Open Access

ARTICLE

Does qSOFA score predict ICU admission and outcomes in patients with obstructed infected ureteral stones?

Phillip Stokes, Mohamed Keheila, Muhannad Alsyouf, Zachary Gilbert, Mohammad Hajiha, Akin Amasyali, Joshua Belle, Jason Groegler, D. Duane Baldwin

Department of Urology, Loma Linda University Health System, Loma Linda, California, USA
Address correspondence to Dr. D. Duane Baldwin, Department of Urology, Loma Linda University Health System, 11234 Anderson Street, Room A560, Loma Linda, CA 92354 USA

Canadian Journal of Urology 2021, 28(5), 10841-10847.

Abstract

Introduction: Obstructing stones with infection represent a true urologic emergency requiring prompt decompression. Historically, the systemic inflammatory response syndrome (SIRS) criteria has been used to predict outcomes in patients with sepsis. The quick Sequential Organ Failure Assessment (qSOFA) score has been proposed as a prognostic factor in patients with acute pyelonephritis associated with nephrolithiasis. However, there has been limited application of qSOFA to patients undergoing ureteral stenting with obstructive pyelonephritis. The purpose of this study was to evaluate the predictive value of the qSOFA score for postoperative outcomes following renal decompression in this patient population.
Materials and methods: A retrospective review was conducted at three medical centers within one academic institution to identify patients with obstructive pyelonephritis secondary to ureteral stones. All patients underwent emergent ureteral stent placement for decompression. The primary outcome was the predictive value of preoperative qSOFA score ≥ 2 for intensive care unit (ICU) admission postoperatively. Univariate analysis and multivariate regression analysis were performed to identify factors associated with postoperative outcomes, with p < 0.05 considered significant.
Results: Of the 289 patients who had ureteral stents placed, 147 patients met inclusion criteria. Twenty-four (16.3%) patients required ICU admission, and there were 3 (2%) mortalities, all of these within the ICU admission group. The sensitivity and specificity of the qSOFA score ≥ 2 for ICU admission was 70.8% and 79.5%, respectively, which outperformed SIRS criteria, which had a sensitivity and specificity of 100% and 33.6%, respectively.
Conclusion: A preoperative qSOFA score ≥ 2 was a significant predictor for postoperative ICU admission in patients undergoing ureteral stent placement for obstructive pyelonephritis. The qSOFA score can be used to determine which patients will require ICU admission.

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