Gender-Based Predictors of Sepsis in Patients Undergoing Urinary Decompression for Obstructive Uropathy

Aim of the study: Epidemiological studies have shown that female patients are at higher risk of developing stone-related infectious complications and urosepsis than their male counterparts. However, this gender-based difference in outcomes has not been specifically explored in the context of obstructive uropathy. This study aimed to investigate gender-related predictors of sepsis in patients treated for obstructive uropathy for ureteral stones. Materials and methods: We retrospectively analyzed clinical, laboratory, and radiological data from 291 consecutive patients presenting to the emergency department for obstructive uropathy because of ureteral stones and submitted to stent or nephrostomy tube decompression between 01/2016 and 10/2024. Comorbidities were assessed using the Charlson Comorbidity Index. Sepsis was defined as an acute increase in ≥2 sequenctial organ failure assesment points and documented blood or urine cultures. All patients underwent preoperative computed tomography. Clinical and stone characteristics were collected in each case. Descriptive statistics and logistic regression models were used to identify gender-specific factors associated with sepsis. Results: In males, sepsis is linked to older age, larger stones, higher white blood cells, and C-reactive protein (CRP). In females, sepsis is linked to older age, higher Charlson Index, creatinine, and CRP. Septic females had smaller stones and lower CRP and creatinine than males. CRP and age were strongest sepsis predictors, with lower thresholds in females. Limitations include single-center, retrospective design, missing data (e.g., antibiotic timing, hormonal status), and reduced power for sex-specific analyses. Larger, prospective studies needed. Conclusions: Female patients with obstructive uropathy had a higher risk of sepsis than men. Clinical and laboratory predictors of sepsis are different according to gender. Female developed sepsis at lower inflammatory scores and smaller stone diameter than males, highlighting that a gender-based management strategy should be performed in patients with obstructive uropathy.