This retrospective multicenter study investigated in-hospital mortality among 483 patients admitted to the ICU (8 centers) over a decade due to obstructive pyelonephritis, a severe condition often caused by kidney stones, cancer, or ureteral stent issues.

Patients were critically ill upon admission, frequently requiring norepinephrine (70%) and mechanical ventilation (23%).

E. coli was the predominant pathogen (63%), with two-thirds of patients having positive blood cultures and 11% infected with Extended-spectrum beta-lactamase-producing bacteria.

Urinary drainage, primarily using double-J stenting (71%), was performed before ICU admission in 43% of cases, within 6 hours in 28%, and after 6 hours in 29%.

Multivariate analysis identified several key factors significantly associated with increased in-hospital mortality: the need for vasopressors, mechanical ventilation, elevated lactate levels (per 1 mmol/l increase), tumor-related obstruction, and stent obstruction.

While overall mortality was high, delayed urinary drainage (>12 hours) was specifically associated with higher mortality only in patients receiving vasopressors (septic shock).

The study concludes that obstructive pyelonephritis is a severe condition leading to significant mortality and strongly recommends that urinary drainage should be performed as soon as possible, especially in patients presenting with septic shock.

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