NEPHROSTOMY tube placement for malignant urinary obstruction is a common and often necessary intervention in oncology care, but it carries a substantial risk of infection and mortality. A retrospective cohort study has identified key clinical, laboratory, and imaging factors associated with sepsis and death following nephrostomy in patients with cancer.
The study, evaluated outcomes in patients who underwent nephrostomy tube insertion for malignancy-related indications at a single centre. Of 517 patients screened, 173 met inclusion criteria. Participants were categorised according to tumour type (urological versus non-urological malignancies) and further stratified based on sepsis development and survival status. Predictive factors for both sepsis and mortality were analysed.
Clinical and Laboratory Predictors of Nephrostomy-Associated Sepsis
The mean patient age was 62.5 years, with a male predominance. Several laboratory markers were significantly associated with the development of sepsis. Patients who became septic had lower post-operative platelet counts, higher post-operative creatinine levels, and lower pre- and post-operative neutrophil and lymphocyte counts. Notably, the neutrophil-to-lymphocyte ratio (NLR) was significantly lower in septic patients, while inflammatory biomarkers, including procalcitonin and C-reactive protein (CRP), were markedly elevated.
Imaging and clinical factors also played an important role. The presence of perirenal fat stranding on imaging and admission to the intensive care unit (ICU) were both significantly associated with sepsis development, highlighting the relevance of early radiological and clinical indicators.
Analysis of mortality risk revealed overlapping but distinct predictors. Lower pre- and post-operative lymphocyte counts and higher procalcitonin levels were significantly associated with death. In addition, elevated post-operative NLR, creatinine, and CRP levels correlated with increased mortality risk. Several patient-related factors were also identified, including diabetes mellitus, immunosuppressive drug use, ICU admission, and the presence of non-urological malignancies, all of which were linked to poorer survival outcomes.
Early Risk Stratification in Nephrostomy Patients
The authors conclude that a combination of inflammatory markers, haematological parameters, imaging findings, and comorbid conditions can help identify patients at high risk of sepsis and mortality following nephrostomy for malignant obstruction. They emphasise that early risk stratification using readily available clinical data may support closer monitoring and targeted management strategies, with the potential to improve outcomes in this 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.
