Early urological source control within 6 h is associated with reduced mortality in critically ill patients with urosepsis: a retrospective cohort study

Urosepsis frequently involves persistent urinary tract obstruction or undrained infection, making effective source control a critical component of management. Although early source control is recommended in sepsis guidelines, evidence defining clinically actionable timing thresholds for urological intervention in critically ill patients with urosepsis requiring source control remains limited. We conducted a retrospective observational cohort study of adult ICU patients with urosepsis requiring urological source control at a tertiary hospital between January 2015 and December 2024. The primary exposure was the timing of intervention, defined as early (≤ 6 h from disease onset) versus delayed (> 6 h). The primary outcome was 28-day all-cause mortality. Survival was analyzed using Kaplan–Meier methods and multivariable Cox proportional hazards regression models. Clinical trial number: not applicable. A total of 539 patients with suspected urinary tract infection, sepsis, or septic shock were screened. After applying exclusion criteria, 49 patients with urosepsis associated with urinary tract obstruction amenable to source control were included, all of whom underwent urological intervention: 29 (59.2%) received early intervention (≤ 6 h) and 20 (40.8%) received delayed intervention (> 6 h). Baseline characteristics were generally balanced between the groups, with borderline differences observed in procalcitonin levels and diabetes mellitus. Kaplan–Meier analysis showed that early intervention was associated with a markedly lower 28-day mortality compared with delayed intervention (3.45% vs 30.00%). In multivariable Cox regression, early intervention remained associated with reduced mortality after adjustment (HR = 0.097, 95% CI: 0.012–0.803; P = 0.031), although the wide confidence intervals indicate uncertainty in the magnitude of this association. In critically ill patients with urosepsis requiring source control, early urological intervention within 6 h of disease onset was associated with a lower risk of short-term mortality. However, given the limited number of outcome events and wide confidence intervals, the magnitude of this association should be interpreted with caution. These findings suggest the potential importance of timely source control in this selected population.