Risk factors for urosepsis in diabetic patients with renal and ureteral calculi: A retrospective study

Urosepsis is a life-threatening condition frequently associated with renal and ureteral calculi (RUC) and diabetes mellitus (DM), a combination that exacerbates susceptibility to infection due to urinary obstruction and impaired immune response.

To identify the risk factors for urosepsis in patients with RUC complicated by DM to enhance early detection and intervention strategies.

This retrospective observational study included 298 patients with RUC and DM admitted between January 2020 and June 2024. Patients were divided into an observation group (n = 32) with urosepsis and a control group (n = 266) without urosepsis. Comprehensive clinical, laboratory, and imaging data were collected and analyzed using univariate and multivariate logistic regression models to identify factors associated with urosepsis. The study adhered to the STROBE guidelines and received ethical approval.

Multivariate analysis identified several independent risk factors for urosepsis. Female sex (OR = 2.237, 95%CI: 1.086-4.605, P = 0.03), advanced age (OR = 1.05, 95%CI: 1.018-1.084, P = 0.002), and fever (OR = 2.999, 95%CI: 1.283-7.015, P = 0.015) significantly increased the risk. Laboratory findings such as elevated urine leukocyte (U-LEU) (+++, OR = 66.0, 95%CI: 7.031-580.125, P < 0.001) and glucose (U-GLU) (+++, OR = 7.248, 95%CI: 1.862-28.211, P = 0.005) levels were strongly associated with urosepsis. Severe hydronephrosis also emerged as a significant predictor (OR = 6.129, 95%CI: 3.027-9.623, P = 0.011). Other factors, such as gross hematuria, stone laterality, and mild to moderate hydronephrosis, were not significantly associated with urosepsis.

This study identifies key demographic, clinical, laboratory, and imaging factors associated with urosepsis risk in patients with RUC and DM. Early identification of female patients, elderly individuals, those presenting with fever, severe hydronephrosis, and elevated U-LEU and U-GLU levels may facilitate timely intervention. These findings highlight the importance of comprehensive assessment and targeted management in the care of high-risk patients.