New Study Identifies Key Risk Factors for Sepsis and Death Following Cancer Nephrostomy
A new study published in July 2025 in New Journal of Urology sheds light on critical factors predicting sepsis and mortality in cancer patients undergoing nephrostomy tube placement for malignant urinary obstruction. The research, a retrospective cohort study, underscores the significant risks associated with the procedure – including infection and death – and offers a pathway toward improved patient monitoring and care.
The procedure, commonly used in oncology care to address urinary blockages caused by cancer, requires careful consideration due to its inherent dangers. Researchers evaluated the outcomes of 173 patients who met specific inclusion criteria after screening 517 individuals at a single medical center. Participants were categorized by tumor type – urological versus non-urological malignancies – and then further stratified based on whether they developed sepsis and their overall survival.
Identifying Vulnerable Patients Through Clinical and Lab Data
The average age of patients in the study was 62.5 years, with a higher proportion being male. The analysis revealed several key laboratory markers associated with the development of sepsis. Patients who became septic exhibited lower post-operative platelet counts, elevated post-operative creatinine levels, and decreased pre- and post-operative neutrophil and lymphocyte counts.
Perhaps most notably, the neutrophil-to-lymphocyte ratio (NLR) was significantly lower in patients who developed sepsis. Simultaneously, levels of inflammatory biomarkers – specifically procalcitonin and C-reactive protein (CRP) – were markedly increased. These findings suggest a potential for early detection through routine bloodwork.
The Role of Imaging and Acute Care
Beyond laboratory results, imaging findings and the need for intensive care also proved to be significant predictors. The presence of perirenal fat stranding – inflammation around the kidney visible on imaging scans – and admission to the intensive care unit (ICU) were both strongly linked to sepsis development. “These indicators highlight the importance of early radiological and clinical assessments,” researchers noted.
Distinct Predictors of Mortality Risk
While some factors overlapped, the predictors of mortality differed slightly from those associated with sepsis. Lower pre- and post-operative lymphocyte counts and higher procalcitonin levels were significantly associated with death. Additionally, elevated post-operative NLR, creatinine, and CRP levels correlated with increased mortality risk.
Several patient-specific factors also contributed to poorer survival outcomes, including a diagnosis of diabetes mellitus, the use of immunosuppressive drugs, ICU admission, and the presence of non-urological malignancies.
Towards Early Risk Stratification and Improved Outcomes
The study’s authors conclude that a comprehensive assessment incorporating inflammatory markers, haematological parameters, imaging findings, and existing comorbid conditions can effectively identify patients at high risk of both sepsis and mortality following nephrostomy for malignant obstruction.
They emphasize that implementing early risk stratification using readily available clinical data could enable closer patient monitoring and more targeted management strategies. This proactive approach, they believe, has the potential to significantly improve outcomes for this particularly vulnerable patient population.
Reference: Uğur R et al. Nephrostomy-Associated Sepsis in Cancer Patients: What Are the Risk Factors? A Retrospective Cohort Study. New J Urol. 2025;20(3):149-158.
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