Risk factors for poor prognosis in adult outpatient urinary tract infection: a meta-analysis
Abstract
Background Risk factors for poor prognosis in outpatient urinary tract infection (UTI) vary across studies and clinical guidelines. Aim To review the evidence on risk factors for poor prognosis in adults’ UTI. Design & setting Systematic review and meta-analysis of observational studies performed in the outpatient setting. Method Five databases and citations of included studies were searched. Two reviewers independently screened studies, abstracted data, and assessed risk of bias (RoB). Random-effects meta-analysis of relative risks (RR) and adjusted odds ratios (aORs) were performed for risk factors reported by ≥3 studies. Results Thirty-five cohort studies including 1 532 790 adults with cystitis or pyelonephritis (PN) were included. Ten were at moderate to high RoB. Increasing age was the only independent predictor of re-consultation (aOR 1.18 per decade). Hospitalisation was associated with high procalcitonin (PCT) (aOR 5.12), increasing age (aOR 3.51 if aged ≥65 years; aOR 1.27 per decade), hypotension (aOR 3.29), fever >38°C (aOR 2.08), elevated C-reactive protein (CRP) (aOR 1.62), creatinine ≥1.2 mg/dl (aOR 1.56), male sex (aOR 1.41), and diabetes (aOR 1.34). In the only study on mortality, among patients aged ≥65 years with cystitis, this outcome was associated with no antibiotics; older age; hospitalisation or antibiotics in prior month; higher comorbidity index; and smoking. Conclusion Older age, male sex, elevated CRP, and diabetes are predictors of adverse…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study
- Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China
- The Role of the NLR and PLR in Urinary Tract Infection
- Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic
- Leclercia adecarboxylata urinary tract infection in a patient with bladder cancer and recurrent hematuria
- A Case Series of Staphylococcus lugdunensis Infection in Cancer Patients at an Academic Cancer Institute in the United States
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.