Obstructive pyelonephritis in intensive care units: A retrospective multicenter study.

Area of Science:

• Nephrology
• Critical Care Medicine
• Infectious Diseases

Background:

• Obstructive pyelonephritis presents a significant threat, frequently leading to organ failure and substantial in-hospital mortality.
• Patients admitted to the intensive care unit (ICU) for this condition often require extensive organ support therapies.

Purpose of the Study:

• To evaluate the in-hospital mortality rates associated with obstructive pyelonephritis.
• To identify prognostic factors influencing mortality in ICU patients with obstructive pyelonephritis.

Main Methods:

• A retrospective, multicenter study included 483 patients admitted to ICUs over a 10-year period.
• In-hospital mortality was the primary outcome measure.
• Multivariate analysis was employed to identify factors associated with mortality.

Main Results:

• Common causes of obstruction included kidney stones, cancer, and ureteral stent issues. Escherichia coli was the predominant pathogen.
• Factors significantly associated with mortality were vasopressor use, mechanical ventilation, elevated lactate levels, tumor-related obstruction, and stent obstruction.
• Delayed urinary drainage (>12 hours) increased mortality risk, especially in patients requiring vasopressors.

Conclusions:

• Obstructive pyelonephritis is a critical illness associated with high in-hospital mortality and organ failure.
• Timely urinary drainage is essential for improving patient outcomes.
• Urgent intervention is particularly vital for patients experiencing septic shock.