Early Urological Source Control Within 6 Hours Is Associated With Reduced Mortality in Critically Ill Patients With Urosepsis: A Retrospective Cohort Study

Background 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 remains limited. Methods We conducted a retrospective observational cohort study of adult patients with urosepsis admitted to the intensive care unit (ICU) of a tertiary hospital between January 2015 and December 2024. The primary exposure was the timing of urological source control, defined as intervention performed within 6 hours of disease onset (early intervention) versus delayed (> 6 hours) or no intervention. The primary outcome was 28-day all-cause mortality. Survival was analyzed using Kaplan–Meier methods and Cox proportional hazards models. Propensity score matching was applied to reduce baseline confounding. Clinical trial number: not applicable. Results A total of 92 ICU patients with urosepsis were included, of whom 29 (31.5%) underwent early urological intervention. Patients in the early intervention group presented with higher serum creatinine and procalcitonin levels at admission, indicating greater acute illness severity. Despite this, early intervention was associated with significantly lower 28-day mortality compared with delayed or no intervention (3.45% vs. 31.75%). Early urological source control remained independently associated with reduced mortality after multivariable adjustment (hazard ratio 24.35 for delayed or no intervention; 95% confidence interval 1.28–465.08). Findings were consistent after propensity score matching. In contrast, antibiotic initiation within 1 hour was not independently associated with survival. Conclusions In critically ill patients with urosepsis, early urological source control within 6 hours of disease onset was strongly associated with reduced short-term mortality, even among patients presenting with greater illness severity. These findings highlight the central role of timely urological intervention and support prioritizing early source control alongside antimicrobial therapy in this high-risk population.