| アブストラクト | 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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| ジャーナル名 | World journal of urology |
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| 投稿日 | 2023/3/23 |
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| 投稿者 | Kamei, Jun; Sugihara, Toru; Yasunaga, Hideo; Matsui, Hiroki; Sasabuchi, Yusuke; Fujimura, Tetsuya; Homma, Yukio; Kume, Haruki |
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| 組織名 | Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke,;Tochigi, 329-0498, Japan. jkamei-tky@umin.ac.jp.;Tochigi, 329-0498, Japan.;Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, Tokyo, Japan.;Data Science Center, Jichi Medical University, Tochigi, Japan.;Department of Urology, Japanese Red Cross Medical Center, Tokyo, Japan.;Department of Urology, Graduate School of Medicine, The University of Tokyo,;Tokyo, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/36947175/ |
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