GENITOURINARY infections are a frequent cause of admission to intensive care units (ICUs) among women and are often complicated by sepsis and acute kidney injury (AKI). While reduced urine output is recognised as a marker of poor prognosis, the clinical significance of dynamic changes in urine output during early ICU stay has remained uncertain. A new retrospective cohort study provides evidence that early urine output trajectories may offer valuable prognostic insight in this high-risk population.
The study analysed data from 1,289 female ICU patients admitted with genitourinary infections. Using latent class growth modelling, researchers examined urine output patterns over the first three days following ICU admission. Patients were categorised into four distinct trajectory classes: persistently low urine output (Class 1; 65.7%), high-to-low urine output (Class 2; 13.7%), persistently high urine output (Class 3; 4.0%), and low-to-high urine output (Class 4; 16.7%). The primary outcome was 28-day all-cause mortality, while the secondary outcome was the development of AKI.
Distinct Urine Output Patterns and Patient Risk Profiles
Marked differences in outcomes were observed across trajectory classes. Patients in the low-to-high urine output group (Class 4) consistently demonstrated the most favourable prognosis and were used as the reference group in multivariable analyses. Compared with this group, mortality risk increased in a graded fashion across the other trajectories. The highest risk was seen in patients with persistently low urine output (Class 1), who had more than a four-fold increased risk of 28-day mortality. Elevated mortality risks were also observed in the high-to-low group (Class 2) and, to a lesser extent, the persistently high group (Class 3).
In addition to mortality differences, the persistently low urine output trajectory was significantly associated with a higher incidence of AKI compared with the low-to-high trajectory. These findings suggest that not only absolute urine volume, but also its early temporal pattern, may reflect evolving renal and haemodynamic dysfunction.
Clinical Implications of Monitoring Urine Output Dynamics
The authors conclude that early urine output trajectories represent a potentially valuable, non-invasive marker for risk stratification in female ICU patients with genitourinary infections. Incorporating dynamic urine output assessment into clinical decision-making may help identify patients at increased risk of death and AKI, enabling earlier and more targeted interventions.
Reference
Chen WH et al. The impact of urine output trajectory on clinical outcomes in female patients with genitourinary infections in the intensive care unit. Sci Rep. 2026;doi: 10.1038/s41598-026-35926-3.
