P0124 The impact Of COVID-19 on acute obstructive pyelonephritis severity - 2020 and its unforeseen presentations

ABSTRACT

INTRODUCTION & Objectives: The World Health Organisation (WHO) announced the coronavirus disease-19 (COVID-19) a pandemic on 12th March 2020. The subsequent diversion of healthcare and public attention towards virus exposure avoidance resulted in an alarming change in emergency department (ED) presentations for many serious medical conditions, namely acute obstructive pyelonephritis (AOP). We sought to assess the impact inflicted by the COVID-19 pandemic on the presentation severity of patients diagnosed with AOP who attended the ED before and after the disease was declared a pandemic. Materials & Methods: We conducted an observational retrospective study analysing data from patients submitted to a temporary urinary diversion with a ureteral double J stent (JJ) from January 2017 to December2020, in a tertiary care centre. Patient cohorts before and after 12th March 2020 were compared. We included patients admitted to the EDwho underwent ureteral stenting in the setting of AOP. We excluded patients submitted to percutaneous urinary diversion and those who underwent JJ placement due to indications other than AOP. Patients' demographics, comorbidities (Charlson Comorbidity Index - CCI), vital signs, chemistry and imaging results at ED admission and during ED stay were analysed. Sequential OrganFailure Assessment (SOFA) score at admission was obtained and the need foradmission in an Intensive Care Unit (ICU)was recorded. The duration of the hospital stay was evaluated. Results: A total of 130 patients were analysed, 97 of those weresubmitted to JJ placement before the COVID-19 outbreak and 33 after. The mean number of patients monthly undergoing a JJ placement raised from 2 to 4 before and after March 2020, respectively. They had comparable age (58±18 vs. 59±18 years old) and comorbidities (as depicted by the CCI) as well as stone location (p=0.292), laterality (p=0.419) and dimension (8mm, p=0.715). Computed Tomography (CT) had a significantly higher use as imaging modality in the ED during the post-COVID-19 era (5.2% vs. 33.3%, p<0.001). There was a non-statistically significant tendency towards a longer time to ED visit in the post-COVID-19 cohort (48 vs. 72 hours,p=0.052). The severity at ED presentation, as evaluated by SOFA score, was identical (p=0.160). Nevertheless, a greater number of patients presented to the ED with sepsis criteria (21.6% vs. 36.4%, p=0.093) and a significantly higher number of patients were admitted to an ICU in the post-COVID-19 period (1% vs. 15.2%, p=0.004) spending 7 days there (on average). Conclusions: The COVID-19 pandemic determined an increase in the number of patients admitted to the ED due to AOP and a higher rate of ICU admission. These findings may be related to the deferral in stone disease elective procedures. The virus exposure avoidance might have led, concurrently, to a longer time until ED visit from the symptom onset.