Long suspected, urologists led by Prof. Haferkamp from Mainz have now provided hard facts for the first time: During the COVID pandemic, other patients also suffer collateral damage. For example, fewer patients with pyelonephritis came to the emergency rooms last year. When they were finally admitted as emergencies, in many cases the disease was already far advanced, with a higher risk of an unfavourable outcome.
With the COVID 19 pandemic, emergency cases in many clinics decreased noticeably within the past year. And although this trend was seen in cardiology as well as in paediatrics or urology, there were no reliable figures on this so far.
A current retrospective, multi-centre study from Germany provides a statistical evaluation for pyelonephritis in urological clinics for the first time. The numbers determined in it speak a clear language and are once again proof that the coronavirus pandemic is leading to collateral damage, some of which is considerable.
In their study, the researchers led by Prof. Haferkamp examined 120 patients with pyelonephritis in the period from March to April in 2019 (before the pandemic) and 2020 (during the COVID-19 pandemic). An important finding of the work was that patients avoided going to emergency departments during the corona pandemic (37% in the pandemic vs. 63% pre-pandemic). This corresponded to a -42% reduction in emergency consultations (p=0.003). There were two main possible reasons for this:
Haferkamp and colleagues also observed that patients with pyelonephritis not only came to the urology clinic less often, but also at a more advanced stage. Especially with regard to the risk of urosepsis, this is a very dangerous, sometimes life-threatening development, since the mortality rate for urosepsis is between 18% and 28%.
For patients, pyelonephritis is difficult to assess and therefore very dangerous. In most cases, the symptoms increase gradually, from fever and flank pain to dysuria and, in particularly severe cases, urosepsis.
On the one hand, the already advanced disease was reflected in the inflammation values in the blood. The number of leucocytes (13.7/µl vs. 11.7/µl) was increased, as was the value for the C-reactive protein (CRP; 83 mg/l vs. 74 mg/l). On the other hand, the number of those with severe courses of disease and adverse outcome increased from 6.6% before Corona to 20.5% during the pandemic.
Original publication:
Borgmann H et al, Increased Severe Adverse Outcomes and Decreased Emergency Room Visits for Pyelonephritis: First Report of Collateral Damage during COVID-19 Pandemic in Urology. Urol Int 2021; 105: 199-205