Exploratory Evaluation of the Fibrosis-4 index, Albumin-bilirubin score, and Neutrophil-lymphocyte ratio (FAN) Sepsis Score for Prognosis in Patients With Poor Performance Status and Sepsis Due to Obstruction by Urinary Calculi.

BACKGROUND/

OBJECTIVES

This study aimed to exploratory evaluate the association between fibrosis-4 index, albumin-bilirubin score, and neutrophil-lymphocyte ratio (FAN) sepsis (FANs) score, a sepsis score derived from fibrosis-4 index, albumin-bilirubin score, and neutrophil-lymphocyte ratio, and the prognosis of patients with poor performance status (PS) and sepsis associated with urinary tract stone obstruction.

METHODS

We identified 56 patients with PS of 3 or 4 who were admitted to Kishiwada Tokushukai Hospital between April 2019 and March 2025 for septic shock due to obstructive pyelonephritis caused by a urinary tract stone. Patient information was collected retrospectively, and the association between prognosis and FANs score was evaluated.

RESULTS

Patient characteristics were evaluated separately for each score group. Although differences were observed in the use of vasopressors, mean arterial pressure, procalcitonin, platelet counts, C-reactive protein, serum creatinine, and sequential organ failure assessment (SOFA) scores (p=0.04, p=0.01, p<0.01, p<0.01, p=0.01, p<0.01, and p<0.01, respectively), there were no other significant differences between the two groups. An increase in the FANs score was associated with increased mortality (p<0.01). Receiver operating characteristic (ROC) curve analysis showed that the FANs score had predictive ability equivalent to the SOFA score for in-hospital, one-year, and overall mortality.

CONCLUSIONS

The FANs score may be associated with the prognosis of patients with poor PS and sepsis due to urinary tract stones.