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22.03.2023 | Original Article

Impact of early ureteral drainage on mortality in obstructive pyelonephritis with urolithiasis: an analysis of the Japanese National Database

verfasst von: Jun Kamei, Toru Sugihara, Hideo Yasunaga, Hiroki Matsui, Yusuke Sasabuchi, Tetsuya Fujimura, Yukio Homma, Haruki Kume

Erschienen in: World Journal of Urology | Ausgabe 5/2023

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Abstract

Background

The impact of early drainage on mortality in patients with obstructive pyelonephritis with urolithiasis was evaluated.

Methods

We identified 34,924 patients in the Japanese Diagnosis Procedure Combination database with obstructive pyelonephritis with urolithiasis receiving ureteral drainage. The effects of early drainage (1–2 days) compared to those of delayed drainage (on 3–4 and ≥ 5 hospital days) on mortality were evaluated among 31,696 patients hospitalized for ≥ 5 days. Multivariate analysis was performed to identify independent factors for mortality.

Results

The mortality rates for overall cases and those hospitalized for ≥ 5 days were 2.0% and 1.6%, respectively. Those receiving drainage on 1–2, 3–4, and ≥ 5 days had mortality rates of 1.5%, 2.0%, and 2.5%, respectively (p < 0.001). Multivariate analysis revealed that delayed drainage was an independent factor for higher mortality (odds ratio [OR] on days 3–4 and ≥ 5; 1.44, p = 0.018; and 1.69, p < 0.001). Increasing age (OR for 60 s, 70 s, and ≥ 80 years; 2.02, 3.85, and 7.77), Charlson comorbidity index score (OR, 1.41 by 1-point increase), disseminated intravascular coagulation (OR, 2.40), ambulance use (OR, 1.22), impaired consciousness at admission (disoriented, arousable with stimulation, and unarousable; OR 1.58, 2.84, and 5.50), and nephrostomy (OR, 1.65) were associated with higher mortality. In contrast, female sex (OR, 0.76) and high hospital volume (OR on 9–16, and ≥ 17 cases/year; 0.80, and 0.75) were associated with lower mortality.

Conclusion

Ureteral drainage within 2 hospital days was an independent factor for low mortality in obstructive pyelonephritis with urolithiasis. Delayed drainage could increase mortality in a time-dependent manner.

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Titel: Impact of early ureteral drainage on mortality in obstructive pyelonephritis with urolithiasis: an analysis of the Japanese National Database
verfasst von: Jun Kamei
Toru Sugihara
Hideo Yasunaga
Hiroki Matsui
Yusuke Sasabuchi
Tetsuya Fujimura
Yukio Homma
Haruki Kume
Publikationsdatum: 22.03.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 5/2023
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04375-2

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Impact of early ureteral drainage on mortality in obstructive pyelonephritis with urolithiasis: an analysis of the Japanese National Database