Acute pyelonephritis in the emergency department: Comparing clinical and prognostic outcomes for community and long-term care

초록

Objective: Acute pyelonephritis in older adults is associated with high morbidity, but clinical characteristics and outcomes in long-term care facility (LTCF) residents-a particularly vulnerable population-remain poorly defined. This study compared clinical features and mortality outcomes of acute pyelonephritis between LTCF residents and community-dwelling older patients (>= 65 years) presenting to the emergency department. Methods: We conducted a retrospective analysis of patients aged >= 65 years diagnosed with acute pyelonephritis between January 2018 and December 2023. Patients were classified as LTCF-acquired or community-acquired acute pyelonephritis. Clinical presentations, laboratory values, and in-hospital mortality were compared. Logistic regression analyses identified independent predictors of in-hospital mortality. Results: Among 831 participants, 187 (22.5%) were LTCF residents. Compared with community-dwelling patients (median age, 78.0 years), the LTCF group was significantly older (median age, 83.0 years). They also showed significantly higher rates of cerebrovascular disease (53.5% vs. 27.9%) and long-term catheter use (37.4% vs. 6.1%), and more frequently presented with altered mental status (42.8% vs. 19.3%), but exhibited fewer urinary tract symptoms (28.3% vs. 73.0%). Overall in-hospital mortality was 4.0% (n = 33). Multivariable analysis identified LTCF residence (OR, 3.73; 95% CI, 1.54-9.04; p = 0.004) and lactate-to-albumin ratio (OR, 2.48; 95% CI, 1.46-4.21; p = 0.001) as independent predictors of mortality. Conclusions: LTCF residents with acute pyelonephritis exhibit atypical clinical presentations, with more frequent altered mental status and fewer urinary symptoms than community-dwelling patients. Both LTCF residency and elevated lactate-to-albumin ratio independently predict mortality, supporting the need for heightened clinical vigilance and tailored management in this vulnerable population. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

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