Evidence mapPaperPMID 40262850Full record

ArticleBJGP open2025

Risk factors for poor prognosis in adult outpatient urinary tract infection: a meta-analysis.

Peter K Kurotschka, Felix Kannapin, Andreas Klug, Maria Chiara Bassi, Ildikó Gágyor, Mark H Ebell

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Article in BJGP open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Peter K KurotschkaUniversity Hospital Wurzburg, Department of General Practice, Wurzburg, Germany kurotschka_p@ukw.de.ORCID https://orcid.org/0000-0003-3750-6147
Felix KannapinUniversity Hospital Wurzburg, Department of General Practice, Wurzburg, Germany.ORCID https://orcid.org/0009-0000-6517-5037
Andreas KlugUniversity Hospital Wurzburg, Department of General Practice, Wurzburg, Germany.ORCID https://orcid.org/0009-0001-4402-080X
Maria Chiara BassiMedical Library, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy.ORCID https://orcid.org/0000-0002-5418-2837
Ildikó GágyorUniversity Hospital Wurzburg, Department of General Practice, Wurzburg, Germany.ORCID https://orcid.org/0000-0002-7974-7603
Mark H EbellDepartment of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States.ORCID https://orcid.org/0000-0003-3228-2877

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRisk factors for poor prognosis in outpatient urinary tract infection (UTI) vary across studies and clinical guidelines.

aimTo review the evidence on risk factors for poor prognosis in adults' UTI. DESIGN &

settingSystematic review and meta-analysis of observational studies performed in the outpatient setting.

methodFive 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.

resultsThirty-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.

conclusionOlder age, male sex, elevated CRP, and diabetes are predictors of adverse outcomes in both patients with cystitis and PN. Elevated PCT, creatinine, hypotension, and fever predict hospitalisation in patients with PN only. These findings support risk stratification and patient management, but further studies are needed to consolidate knowledge on risk factors, especially for patients with cystitis.

Indexed as

CystitisGeneral practiceOutpatientsPrognosisPyelonephritisUrinary tract infections

Identifiers

PMID40262850
PMCPMC12728881

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.