Effect of early intubation on patient-centered outcomes in urosepsis: a retrospective multicenter cohort study.

Abstract

Background: Urosepsis has a reported mortality rate of up to 13.5%, and approximately 38% of affected patients require intubation. This study evaluated the association between the timing of intubation and in-hospital mortality among patients with urosepsis.

Methods: We conducted a multicenter retrospective cohort study using the Australian and New Zealand Intensive Care Registry Adult Patient Database. Adult ICU patients (≥ 16 years) with a primary diagnosis of urosepsis admitted between 1 January 2018 and 1 April 2023 were included. Patients were classified into early (≤ 24 h from ICU admission) or delayed (> 24 h) intubation groups. The primary outcome was in-hospital mortality. Secondary outcomes included ICU and hospital lengths of stay (LOS), mortality at 6, and 12 months. Outcomes were analyzed using multivariable logistic or linear regression models.

Results: Of 1,235 patients across 151 sites, 983 patients (79.6%) received early intubation. In-hospital mortality was similar between early and delayed intubation groups (19.2% vs. 17.5%, p = 0.52). Early intubation was not associated with in-hospital mortality (adjusted odds ratio [OR] = 0.76; 95% confidence intervals [95% CI] 0.51-1.13). Patients with early intubation had shorter ICU LOS (adjusted point estimate = -2.94 days; 95% CI -3.90 to -1.98) but not hospital LOS. There was no association between early intubation and mortality at 6 months (adjusted OR = 0.76; 95% CI 0.53-1.10) and 12 months (adjusted OR = 0.75; 95% CI 0.53-1.06).

Conclusions: Early intubation within the first 24 h after ICU admission was not associated with reduced in-hospital or long-term mortality among patients with urosepsis.

Trial registration: Alfred Hospital Ethics Committee (Reference 762/24) and the Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation Management Committee.