Journal of critical care · 2025
Obstructive pyelonephritis in intensive care units: A retrospective multicenter study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Gabarre Paul, Dumas Guillaume, Raymond Matthieu, Ledoux Geoffrey, Meunier Juliette, Lavillegrand Jean-Rémi, Blaise Tom, Thiry Ingrid, Le Breton Camille, Gele-Decaudin Guillaume, Joffre Jérémie, Maury Eric, Gaudry Stéphane, Voiriot Guillaume, De Prost Nicolas, Guitton Christophe, Préau Sébastien, Canet Emmanuel, Ait-Oufella Hafid
Аннотация
STUDY OBJECTIVE: We aimed to evaluate mortality and prognostic factors of patients admitted to ICU for obstructive pyelonephritis.
METHOD: We conducted a retrospective multicenter study. All patients admitted to an intensive care unit (ICU, N = 8) for obstructive pyelonephritis were included. The primary outcome was in-hospital mortality.
RESULTS: A total of 483 patients were included over a 10-year period. Disease was severe at admission with frequent organ support therapy including norepinephrine infusion (70 %) and invasive mechanical ventilation (23 %). The most frequent causes of obstruction were kidney stones, cancer, and ureteral stent obstruction. Escherichia coli was the most prevalent pathogen identified in urine (63 %), and two-thirds of patients had positive blood cultures. Infection with Extended-spectrum beta-lactamase-producing bacteria was observed in 53 (11 %) patients. Urinary drainage was performed either before ICU admission (43 %), < 6 h (28 %), or > 6 h (29 %), mainly using double-J stenting (71 %). In multivariate analysis, factors associated with in-hospital mortality were the need for vasopressors (OR: 3.27 [95 % CI 1.33-8.06], p = 0.01), mechanical ventilation (OR: 2.49 [95 % CI 1.35-4.59, p = 0.004]), lactate levels (per 1 mmol/l increase) (OR: 1.18 [95 % CI 1.06-1.31, p = 0.004]), tumor-related obstruction (OR: 4.78 [95 % CI 2.24-10.17], p < 0.001), and stent obstruction (OR: 3.38 [95 % CI 1.44-7.93, p = 0.005]). Delayed urinary drainage (>12 h) was associated with mortality only in patients receiving vasopressors.
CONCLUSION: Obstructive pyelonephritis is a severe condition leading to organ failure and significant in-hospital mortality. Urinary drainage should be performed as soon as possible, especially in patients with septic shock.
METHOD: We conducted a retrospective multicenter study. All patients admitted to an intensive care unit (ICU, N = 8) for obstructive pyelonephritis were included. The primary outcome was in-hospital mortality.
RESULTS: A total of 483 patients were included over a 10-year period. Disease was severe at admission with frequent organ support therapy including norepinephrine infusion (70 %) and invasive mechanical ventilation (23 %). The most frequent causes of obstruction were kidney stones, cancer, and ureteral stent obstruction. Escherichia coli was the most prevalent pathogen identified in urine (63 %), and two-thirds of patients had positive blood cultures. Infection with Extended-spectrum beta-lactamase-producing bacteria was observed in 53 (11 %) patients. Urinary drainage was performed either before ICU admission (43 %), < 6 h (28 %), or > 6 h (29 %), mainly using double-J stenting (71 %). In multivariate analysis, factors associated with in-hospital mortality were the need for vasopressors (OR: 3.27 [95 % CI 1.33-8.06], p = 0.01), mechanical ventilation (OR: 2.49 [95 % CI 1.35-4.59, p = 0.004]), lactate levels (per 1 mmol/l increase) (OR: 1.18 [95 % CI 1.06-1.31, p = 0.004]), tumor-related obstruction (OR: 4.78 [95 % CI 2.24-10.17], p < 0.001), and stent obstruction (OR: 3.38 [95 % CI 1.44-7.93, p = 0.005]). Delayed urinary drainage (>12 h) was associated with mortality only in patients receiving vasopressors.
CONCLUSION: Obstructive pyelonephritis is a severe condition leading to organ failure and significant in-hospital mortality. Urinary drainage should be performed as soon as possible, especially in patients with septic shock.