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

## TL;DR

This study found that early intubation in urosepsis patients does not reduce mortality but may shorten ICU stays.

## Contribution

The study is the first to investigate the impact of early intubation on mortality in urosepsis patients using a large multicenter dataset.

## Key findings

- Early intubation was not associated with reduced in-hospital mortality in urosepsis patients.
- Early intubation was linked to shorter ICU length of stay but not hospital length of stay.
- No significant long-term mortality benefit was observed with early intubation.

## Abstract

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.

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.

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).

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.

The online version contains supplementary material available at 10.1186/s40560-025-00829-4.