Predicting Septic Shock After Emergent Ureteral Stenting in Stone-Related Obstruction and Presumed Infections

Introduction: Systemic inflammatory response syndrome (SIRS) criteria have long been used to predict septic shock. The sequential organ failure assessment and quick sequential organ failure assessment (qSOFA) scores have been suggested to be more accurate predictors. This study aims to compare SIRS and qSOFA for predicting of septic shock in the setting of retrograde ureteral stenting for obstructing stones and concomitant urinary tract infection. Methods: A retrospective review of records at two centers of consecutive patients was performed. Patients with unilateral ureteral obstruction by a stone who underwent ureteral stent placement and suspicion of urinary tract infection were identified. Primary endpoints were SIRS and qSOFA positive scores, intensive care unit admission, and vasopressor requirements. Results: A total of 187 patients were included. SIRS criteria were met in 103 patients (55.1%) and in 30 patients who experienced septic shock. qSOFA criteria were met for 24 patients (12.8%) and in 18 patients who experienced septic shock. Specificity for postoperative septic shock was significantly higher for qSOFA than for SIRS criteria (75 vs 29.1%, McNemar test p<0.001). Both SIRS and qSOFA had significant areas under the curve (AUC), qSOFA had a fair AUC of 0.750, p=0.001, whereas SIRS had a poor AUC of 0.659, p=0.008. Univariate logistic regression of SIRS and qSOFA for septic shock showed: qSOFA (odds ratio [OR] 46 [0.25-228], p=0.001) and SIRS (OR 2.29 [0.716-7.37], p=0.162). Conclusion: Although SIRS offers higher sensitivity, qSOFA score may offer advantages over SIRS criteria in evaluation of risk for septic shock for patients who present with obstructing ureteral stone and urinary tract infection.