Endourology & Stone Disease(구연) (E-160) 요로 결석에 의해 발생한 폐색성 신우신염에서 패혈성 쇼크의 위험인자 경북대학교병원 비뇨의학과¹ 칠곡경북대학교병원 비뇨의학과² 경북대학교 의과대학 비뇨기과학교실³ 민경찬¹, 변경현², 장세원¹, 강재훈², 유은상¹³, 이준녕¹³, 김범수¹³ Introduction : Though there are several studies related to predictors of urosepsis in obstructive acute pyelonephritis (APN), few studies have analyzed risk factors of septic shock in obstructive APN associated with upper urinary tract calculi (obstructive APN–UTC). Since newly defined sepsis-3 criteria was announced at 2016, novel research to analyze predictors for septic shock based on this criteria is needed. This study aimed to find predictors of septic shock in obstructive APN-UTC using sepsis-3 criteria. Materials and methods : From March 2014 to February 2020, a total of 1499 patients underwent percutaneous nephrostomy (PCN) in a single institution due to obstructive uropathy. Of these patients, patients with obstructive APN associated with unilateral upper urinary tract stone were enrolled in this study. Patients with bilateral obstruction, maintaining long-term PCN, single kidney or non-functioning contralateral kidney, and combined other infection site, such as pneumonia were excluded. Gender, age, underlying diseases, performance status, hydronephrosis, parenchymal thinning, urine/blood culture, serum procalcitonin (PCT), absolute lymphocyte count (ALC), neutrophil-to-lymphocyte ratio, albumin-to-globulin ratio and the results of other laboratory tests were used as independent variables for the analysis. Results : Out of 1499 patients, 81 patients met the selection criteria, and 37 patients were included in the septic shock group. Other 37 patients from non-septic shock group were selected as age-matched controls. Analysis about performance status, gender and presence of comorbid diseases showed no significant difference between the groups. Multivariable logistic regression analysis showed serum PCT (9.48 vs. 62.29, p<0.001, OR 1.060 [1.031-1.091]) and ALC (970 vs. 492, p=0.007, OR 0.997 [0.995-0.999])) were independent predictors of septic shock. Area under the curve of PCT was 0.931±0.029 (cutoff value: 15.015, sensitivity 89.2%, specificity 86.5%) and that of ALC was 0.813±0.049 (cutoff value: 595, sensitivity 73%, specificity 73%). Conclusions : This study demonstrated that serum PCT and ALC can be useful predictors of septic shock in obstructive APN caused by unilateral ureteral stone. keywords : septic shock, procalcitonin, urolithiasis