Management and outcomes of urosepsis due to urolithiasis: a retrospective observational study at a tertiary hospital

Urolithiasis-associated urosepsis is a urological emergency in which urinary obstruction may accelerate deterioration in the patient’s clinical condition by promoting progression of infection, organ dysfunction, and hemodynamic instability, and increase intensive care unit (ICU) utilization. Local data on management patterns and predictors of ICU admission in Palestine are scarce. This study evaluated clinical characteristics, intervention patterns, and determinants of ICU admission among adults with urosepsis secondary to urolithiasis at a tertiary center in the West Bank. A retrospective observational study was conducted (2017–2025) including adults with urolithiasis-related urosepsis. Demographics, comorbidities, laboratory values, stone characteristics, and decompression modality (Double-J stent, percutaneous nephrostomy [PCN], or other) were collected. Outcomes included ICU admission and hospital length of stay. Group comparisons and logistic regression analyses were performed. Platelet count performance for ICU prediction was assessed using ROC analysis. A total of 158 patients were included; 23 (14.6%) required ICU admission and 135 (85.4%) were managed on the ward. ICU patients were older (56.7 ± 11.5 vs. 47.5 ± 16.6 years; p = 0.002), more often female (56.5% vs. 33.3%; p = 0.033), and had higher rates of diabetes mellitus (52.2% vs. 28.9%; p = 0.027) and chronic kidney disease (17.4% vs. 3.7%; p = 0.027). Platelet counts were significantly lower in ICU patients (187.9 ± 112.2 vs. 276.7 ± 109.4 × 10³/µL; p = 0.001), and ICU stay was associated with longer hospitalization (8.2 ± 5.6 vs. 2.6 ± 3.8 days; p < 0.001). ICU admission differed by intervention ( p = 0.009), with the highest rate in the PCN group (40.0%). In univariate analysis, age, female sex, diabetes, chronic kidney disease, PCN (vs. Double-J stent), and lower platelet count predicted ICU admission. In multivariate analysis, only low admission platelet count remained independently associated with ICU admission (aOR 0.990 (95% CI 0.984–0.996) per 1 × 10³/µL increase in platelet count; p = 0.002). Platelet count showed fair discrimination (AUC = 0.708; p = 0.001), with a cut-off of 189.0 × 10³/µL (sensitivity 80.6%, specificity 56.5%). In this West Bank cohort, ICU admission in urolithiasis-associated urosepsis correlated with older age, comorbidity burden and, most notably, thrombocytopenia. Admission platelet count may aid early risk stratification and triage alongside clinical assessment.