1. Uroseptic Shock Can Be Reversed by Early Intervention Based on Leukocyte Count 2 h Post-operation: Animal Model and Multicenter Clinical Cohort Study.
- Author
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Wu H, Wang Z, Zhu S, Rao D, Hu L, Qiao L, Chen Y, Yan J, Chen X, Wan SP, Schulsinger DA, and Li G
- Subjects
- Adult, Animals, Humans, Length of Stay, Leukocyte Count, Lithotripsy mortality, Middle Aged, Rabbits, Retrospective Studies, Shock, Septic diagnosis, Shock, Septic mortality, Urinary Tract Infections diagnosis, Urinary Tract Infections etiology, Urinary Tract Infections mortality, Early Medical Intervention, Lithotripsy adverse effects, Shock, Septic etiology
- Abstract
This study investigated whether early intervention based on leukocyte count (WBC) of less than 2.85 × 10
9 /L obtained within 2 h post-operatively may ameliorate the uroseptic shock induced by upper urinary tract endoscopic lithotripsy (UUTEL). Urosepsis was induced in 30 rabbits and assigned to three groups: Control-I, WBC-I, and Shock-I. Control-I: Non-intervention control. WBC-I: Immediate resuscitation when there was a drastic drop of WBC within 2 h post-operatively but without signs or symptoms of shock. Shock-I: Resuscitation only when there were signs or symptoms of shock. In total, 107 patients whose WBC were less than 2.85 × 109 /L within 2 h after UUTEL were retrospectively analyzed. Patients were assigned into two groups based on the time of the intervention. Shock-II included 59 patients who were started on the resuscitation bundle when there were signs or symptoms of shock. WBC-II included 48 patients who were started immediately on the resuscitation bundle when the WBC decreased drastically. All Control-I rabbits developed shock within 72 h and died. None of the WBC-I rabbits developed shock and all survived for 72 h. In total, 60% of Shock-I died within 72 h. Overall, 43 patients in Shock-II and six patients in WBC-II experienced uroseptic shock. The average lengths of hospitalization for Shock-II and WBC-II were 17.8 ± 9.7 days and 7 ± 4.2 days, respectively. Six patients in the Shock-II and none in WBC-II died of the uroseptic shock. Early intervention based on WBC measured within 2 h post-operatively might avert the uroseptic shock induced by UUTEL. more...- Published
- 2018
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