Factors influencing the flare of inflammatory markers after drainage of obstruction for patients with obstructive urosepsis

Abstract 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.