Early Urological Source Control Within 6 Hours Is Associated With Reduced Mortality in Critically Ill Patients With Urosepsis: A Retrospective Cohort Study
Yue
Ouyang
MD
1
Houcheng
Li
MD
1
Shaowu
Chen
MB
2
Guanxiong
Liu
MB
2
Wenxiao
Luo
MB
2
Dan
He
MB
1
Yucheng
Li
MB
1
Zhenhua
Zeng
PhD
1✉
Emailzhenhuazeng.2008@163.com
A
A
Guoneng
Gan
MB
2,3✉
1
Department of Critical Care Medicine
Nanfang Hospital, Southern Medical University
510515
Guangzhou
China
2
Department of Critical Care Medicine
Yunfu People’s Hospital
527300
Yunfu
China
3
Department of Critical Care Medicine
Yunfu People’s Hospital
120 Huanshi East Road, Yuncheng District
527300
Yunfu City
Guangdong Province
China
Yue Ouyang, MD1#, Houcheng Li, MD1#, Shaowu Chen, MB2, Guanxiong Liu, MB 2, Wenxiao Luo, MB 2, Dan He, MB1, Yucheng Li, MB1, Zhenhua Zeng, PhD1*, Guoneng Gan, MB2*
1 Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
2 Department of Critical Care Medicine, Yunfu People’s Hospital, Yunfu 527300, China.
* Corresponding Author: Zhenhua Zeng, PhD, Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. Email: zhenhuazeng.2008@163.com;
Guoneng Gan, MB, Department of Critical Care Medicine, Yunfu People’s Hospital, 120 Huanshi East Road, Yuncheng District, Yunfu City, Guangdong Province 527300, China.
Running Title
Yue Ouyang MD and Houcheng Li MD contributed equally to this work.
Timing of Urological Source Control in Urosepsis
Declaration
of generative AI and AI-assisted technologies in the manuscript preparation process
During the preparation of this manuscript, the authors used ChatGPT (version 5.2) as an AI-assisted tool to support language editing, stylistic refinement, and organization of the manuscript text. The tool was used to improve clarity, coherence, and academic expression, without generating original scientific content, data, results, or interpretations.
All content produced with the assistance of this tool was critically reviewed, revised, and approved by the authors.
A
The authors take full responsibility for the integrity, accuracy, and originality of the manuscript, as well as for compliance with ethical standards and journal policies.
Early Urological Source Control Within 6 Hours Is Associated With Reduced Mortality in Critically Ill Patients With Urosepsis: A Retrospective Cohort Study
A
Abstract
Background
A
Urosepsis frequently involves persistent urinary tract obstruction or undrained infection, making effective source control a critical component of management. A
Although early source control is recommended in sepsis guidelines, evidence defining clinically actionable timing thresholds for urological intervention in critically ill patients with urosepsis remains limited.Methods
A
A
We conducted a retrospective observational cohort study of adult patients with urosepsis admitted to the intensive care unit (ICU) of a tertiary hospital between January 2015 and December 2024. The primary exposure was the timing of urological source control, defined as intervention performed within 6 hours of disease onset (early intervention) versus delayed (> 6 hours) or no intervention. The primary outcome was 28-day all-cause mortality. Survival was analyzed using Kaplan–Meier methods and Cox proportional hazards models. Propensity score matching was applied to reduce baseline confounding. Clinical trial number: not applicable.Results
A total of 92 ICU patients with urosepsis were included, of whom 29 (31.5%) underwent early urological intervention. Patients in the early intervention group presented with higher serum creatinine and procalcitonin levels at admission, indicating greater acute illness severity. Despite this, early intervention was associated with significantly lower 28-day mortality compared with delayed or no intervention (3.45% vs. 31.75%). Early urological source control remained independently associated with reduced mortality after multivariable adjustment (hazard ratio 24.35 for delayed or no intervention; 95% confidence interval 1.28–465.08). Findings were consistent after propensity score matching. In contrast, antibiotic initiation within 1 hour was not independently associated with survival.
Conclusions
In critically ill patients with urosepsis, early urological source control within 6 hours of disease onset was strongly associated with reduced short-term mortality, even among patients presenting with greater illness severity. These findings highlight the central role of timely urological intervention and support prioritizing early source control alongside antimicrobial therapy in this high-risk population.
Keywords:
Urosepsis
Source control༛Surgical timing༛Intensive care unit༛Mortality
Key Findings
Early urological source control within 6 hours of disease onset was strongly associated with reduced 28-day mortality in ICU patients with urosepsis. This association persisted after rigorous adjustment for disease severity and clinical confounders and remained consistent following propensity score matching. Importantly, early surgical intervention was associated with improved survival despite higher markers of acute illness severity at presentation, highlighting the critical importance of timely source control in this population.
A
Background
Urosepsis is a common cause of intensive care unit (ICU) admission and is frequently complicated by urinary tract obstruction, impaired drainage, or localized infectious collections. These anatomical characteristics distinguish urosepsis from other sources of sepsis and render effective urological source control a central component of treatment(1, 2).
International sepsis guidelines emphasize early source control in addition to prompt antimicrobial therapy; however, recommendations regarding the timing of surgical or procedural intervention remain largely nonspecific, particularly for urosepsis(3, 4). While “early” source control is broadly advocated, explicit and clinically actionable time thresholds for urological intervention are lacking. Consequently, surgical intervention in critically ill patients is often deferred in favor of prolonged medical stabilization, even in the presence of persistent obstruction or undrained infection.
From a pathophysiological perspective, ongoing urinary tract obstruction or abscess formation may serve as a continuous nidus of infection, sustaining systemic inflammation and progressive organ dysfunction despite appropriate antimicrobial therapy(3, 5). Observational studies in heterogeneous sepsis populations have demonstrated that delays in achieving source control are associated with increased mortality, especially among patients with septic shock (6, 7). However, these studies often include mixed infection sources and may not adequately reflect the distinct clinical course of urosepsis.
Recent urology-focused studies have provided disease-specific evidence suggesting that earlier urinary drainage in obstructive pyelonephritis is associated with improved outcomes, whereas delays in decompression may increase mortality in a time-dependent manner(8, 9). Nevertheless, most existing data are derived from administrative databases or non-ICU cohorts, and evidence specifically addressing critically ill ICU patients with urosepsis remains limited.
In parallel, increasing emphasis has been placed on very early antibiotic administration, often within a 1-hour target. Emerging evidence, however, suggests that the survival benefit of increasingly stringent antibiotic time thresholds may vary across sepsis subgroups and clinical contexts(10, 11). In patients with urosepsis complicated by ongoing obstruction or undrained infection, early antibiotics may be necessary but insufficient when definitive source control is delayed.
Therefore, we conducted a retrospective cohort study of ICU patients with urosepsis to evaluate whether early urological source control within a clinically actionable time window is associated with reduced short-term mortality.
Methods
Study design and setting
This was a retrospective observational cohort study conducted in the ICU of Yunfu People’s Hospital, Guangdong Province, China. The study was designed and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement (12).
Study population
Adult patients (≥ 18 years) admitted to the ICU between January 2015 and December 2024 were screened for eligibility. Urosepsis was defined as sepsis originating from the urinary tract, based on clinical presentation, microbiological findings, imaging results, and urologist assessment (1, 2). Sepsis was identified according to the Sepsis-3 criteria, defined as suspected or confirmed infection accompanied by acute organ dysfunction(13).
Patients were excluded if sepsis originated from a non-urinary source, if key data required to determine exposure timing were missing, or if ICU length of stay was less than 24 hours. For patients with multiple ICU admissions, only the first admission was included.
Exposure definition: timing of urological source control
The primary exposure of interest was the timing of urological source control. Urological source control was defined as any surgical or procedural intervention aimed at relieving urinary tract obstruction or draining infected collections, including ureteral stent placement, percutaneous nephrostomy, or surgical drainage.
Based on prior sepsis literature emphasizing hours-level decision-making for source control, exposure groups were defined a priori as early intervention (source control performed within 6 hours of disease onset) and delayed or no intervention (performed more than 6 hours after onset or not performed) (6, 7). The time of disease onset was determined as the earliest documented time of symptom onset or clinical recognition of sepsis.
Data collection and severity assessment
Demographic characteristics, comorbidities, laboratory data, imaging findings, treatment variables, and outcomes were extracted from the electronic medical record system. Disease severity was assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the Sequential Organ Failure Assessment (SOFA) score, calculated within the first 24 hours of ICU admission.
Outcome measures
The primary outcome was 28-day all-cause mortality. Secondary outcomes included ICU length of stay and hospital length of stay.
Statistical analysis
Continuous variables were expressed as mean ± standard deviation or median with interquartile range and compared using the Student’s t test or Mann–Whitney U test, as appropriate. Categorical variables were compared using the χ² test or Fisher’s exact test.
Overall survival was evaluated using Kaplan–Meier curves and compared with the log-rank test. Cox proportional hazards regression models were used to estimate the association between timing of urological source control and 28-day mortality, with results expressed as hazard ratios and 95% confidence intervals.
To reduce baseline confounding, propensity score matching was performed using nearest-neighbor matching with a caliper width of 0.2 of the standard deviation of the logit of the propensity score. After matching, 48 patients (26 in the early intervention group and 22 in the delayed or no intervention group) were retained for the matched analysis. Covariate balance before and after matching was assessed using standardized mean differences, with an absolute value < 0.20 indicating adequate balance. A two-sided P value < 0.05 was considered statistically significant.
Ethical considerations
A
A
The study protocol was approved by the institutional ethics committee of Yunfu People’s Hospital. A
The requirement for informed consent was waived due to the retrospective nature of the study.Results
Study Population and Exposure Definition
Between January 2015 and December 2024, a total of 92 consecutive patients with urosepsis admitted to the intensive care unit (ICU) of Yunfu People’s Hospital were included in the final analysis. The primary exposure of interest was the timing of urological source control, defined a priori as surgical intervention performed within 6 hours of disease onset (early intervention) versus delayed intervention (> 6 hours) or no surgical intervention (Fig. 1).
Fig. 1
Flowchart of patient selection.
Among the included patients, 29 (31.5%) underwent early urological intervention within 6 hours, while 63 (68.5%) received delayed intervention or no surgical intervention (Table 1).
|
Variable
|
Overall (n = 92)
|
≤ 6 h surgery (n = 29)
|
> 6 h / no surgery (n = 63)
|
P value
|
|---|---|---|---|---|
|
Age, years
|
66.41 ± 13.84
|
62.62 ± 13.86
|
68.16 ± 13.59
|
0.074
|
|
Male sex, n (%)
|
31 (33.7)
|
7 (24.1)
|
24 (38.1)
|
0.188
|
|
APACHE II score
|
23.50 ± 5.84
|
25.14 ± 6.37
|
22.75 ± 5.47
|
0.068
|
|
SOFA score
|
8.79 ± 4.10
|
9.59 ± 3.27
|
8.43 ± 4.40
|
0.210
|
|
Time from onset to ICU admission, days
|
2.0 (0.0–3.0)
|
2.0 (1.0–3.0)
|
1.0 (0.0–3.0)
|
0.461
|
|
Serum creatinine, µmol/L
|
250.1 (134.9–389.3)
|
285.4 (238.0–422.9)
|
212.9 (121.4–328.4)
|
0.003
|
|
Procalcitonin, ng/mL
|
79.25 (8.48–100.0)
|
100.0 (81.7–100.0)
|
26.19 (4.06–100.0)
|
< 0.001
|
|
Diabetes mellitus, n (%)
|
36 (39.1)
|
7 (24.1)
|
29 (46.0)
|
0.046
|
|
Septic shock, n (%)
|
52 (56.5)
|
18 (62.1)
|
34 (54.0)
|
0.466
|
|
Urinary tract abscess, n (%)
|
23 (25.0)
|
11 (37.9)
|
12 (19.1)
|
0.052
|
|
Ureteral obstruction, n (%)
|
55 (59.8)
|
29 (100.0)
|
26 (41.3)
|
< 0.001
|
|
Variable
|
Model 1 HR (95% CI)
|
P value
|
Model 2 HR (95% CI)
|
P value
|
Model 3 HR (95% CI)
|
P value
|
|---|---|---|---|---|---|---|
|
≤ 6 h surgery
|
Reference
|
—
|
Reference
|
—
|
Reference
|
—
|
|
> 6 h / no surgery
|
6.84 (0.83–56.18)
|
0.073
|
7.38 (0.87–62.78)
|
0.067
|
24.35 (1.28–465.08)
|
0.034
|
| Model 1: unadjusted. | ||||||
| Model 2: adjusted for age and sex. | ||||||
| Model 3: adjusted for age, sex, diabetes mellitus, urinary tract abscess, septic shock, APACHE II score, procalcitonin, and time from onset to ICU admission. | ||||||
| Contextual Analysis: Timing of Antibiotic Initiation | ||||||
| As a contextual comparison, the timing of antibiotic initiation was examined in relation to 28-day mortality. In contrast to surgical timing, initiation of antibiotics within 1 hour of disease onset was not independently associated with improved survival after adjustment for clinical severity and relevant confounders (Supplementary Fig. 1 and Supplementary Table 1). This finding underscores the dominant prognostic role of timely urological source control in this cohort of critically ill patients with urosepsis. | ||||||
| Discussion | ||||||
| In this retrospective cohort of critically ill patients with urosepsis, we found that early urological source control performed within 6 hours of disease onset was strongly associated with reduced 28-day mortality. This association remained robust after multivariable adjustment and propensity score matching, supporting the clinical importance of timely urological intervention in this high-risk population. | ||||||
| Urosepsis is frequently driven by persistent urinary tract obstruction or undrained infection, conditions that may sustain systemic inflammation despite appropriate antimicrobial therapy(2, 3). International guidelines consistently emphasize early source control as a cornerstone of sepsis management, yet provide limited source-specific guidance regarding optimal timing (4, 5). Our findings contribute to this gap by suggesting that, in urosepsis, hours-level delays in achieving source control may have meaningful prognostic consequences. | ||||||
| Importantly, patients undergoing early urological intervention in our cohort presented with greater biochemical abnormalities, including higher creatinine and procalcitonin levels, indicating more severe acute illness. Despite this unfavorable baseline profile, early intervention was associated with improved survival, arguing against simple selection of lower-risk patients and supporting a potentially causal role of timely source control(6, 7). | ||||||
| Our results are consistent with prior observational studies demonstrating that delayed source control is associated with increased mortality in sepsis and septic shock(6, 7). Moreover, urology-focused studies in obstructive pyelonephritis have shown that earlier urinary drainage is associated with improved outcomes, whereas delays in decompression may increase mortality in a time-dependent manner (8, 9). Together, these data provide disease-specific biological plausibility for the survival benefit observed in our study. | ||||||
| In contrast, antibiotic initiation within 1 hour was not independently associated with survival in our cohort. While prompt antimicrobial therapy remains essential and strongly recommended by guidelines (4), emerging evidence suggests that the benefit of increasingly stringent antibiotic time targets may vary across clinical contexts (10, 11). In urosepsis complicated by ongoing obstruction or undrained infection, early antibiotics alone may be insufficient when definitive source control is delayed. | ||||||
| Several limitations should be acknowledged. The retrospective single-center design limits causal inference and generalizability, and residual confounding cannot be completely excluded. The relatively small sample size likely contributed to wide confidence intervals, reflecting imprecision in effect magnitude rather than inconsistency in effect direction. Nevertheless, the consistency of findings across multiple analytical approaches strengthens the credibility of our results. | ||||||
| In conclusion, our study suggests that early urological source control within 6 hours of disease onset is a dominant determinant of short-term survival in critically ill patients with urosepsis. These findings support prioritizing timely urological intervention alongside antimicrobial therapy in ICU care pathways for this population. | ||||||
Data are presented as mean ± SD, median (IQR), or number (%).
Baseline Characteristics and Initial Disease Severity
Baseline demographic and clinical characteristics prior to propensity score matching are summarized in Table 1. Age, sex distribution, and overall illness severity, as assessed by APACHE II and SOFA scores, were comparable between the early intervention and delayed or non-intervention groups.
Notably, patients undergoing early urological intervention presented with biochemical markers indicative of greater acute illness severity, including significantly higher serum creatinine levels and markedly elevated procalcitonin concentrations at ICU admission. These findings suggest that early surgical intervention was not preferentially applied to patients with a lower severity profile. In contrast, diabetes mellitus was less prevalent in the early intervention group, whereas anatomical factors directly related to urinary obstruction—such as ureteral obstruction and urinary tract abscess—were more frequently observed.
Despite this unfavorable biochemical profile at presentation, patients who underwent early surgical intervention exhibited a substantially lower 28-day mortality compared with those receiving delayed or no intervention, indicating a potential survival benefit associated with timely urological source control.
Propensity Score Matching and Covariate Balance
To further address baseline imbalances and reduce potential confounding, a 1:1 propensity score matching (PSM) analysis was performed using nearest-neighbor matching with a caliper width of 0.2. Variables included in the matching process were age, sex, APACHE II score, procalcitonin level, diabetes mellitus, presence of urinary tract abscess, septic shock, and time from symptom onset to ICU admission.
A
After matching, 48 patients were included in the matched cohort, consisting of 26 patients in the early intervention group and 22 patients in the delayed or non-intervention group. Post-matching assessment demonstrated adequate covariate balance, with all standardized mean differences below 0.20 (Table 2), indicating good comparability between groups. Importantly, the direction of the association between surgical timing and mortality observed in the unmatched cohort remained consistent after propensity score matching, supporting the robustness of the primary findings.
Table 2. Covariate balance before and after propensity score matching
|
Variable
|
Before PSM SMD
|
After PSM SMD
|
|---|---|---|
|
Age
|
0.408
|
0.174
|
|
Time from onset to ICU admission
|
0.077
|
0.172
|
|
APACHE II score
|
0.438
|
0.103
|
|
Procalcitonin
|
0.812
|
0.315
|
|
Male sex
|
0.287
|
0.188
|
|
Diabetes mellitus
|
0.439
|
0.196
|
|
Urinary tract abscess
|
0.481
|
0.060
|
|
Septic shock
|
0.163
|
0.124
|
Abbreviations: PSM, propensity score matching; SMD, standardized mean difference.
An absolute SMD < 0.20 was considered indicative of adequate covariate balance.
Association Between Surgical Timing and Survival
Unadjusted Survival Analysis
Kaplan–Meier survival analysis demonstrated a clear separation between groups stratified by timing of urological intervention (Fig. 2). Patients in the delayed or non-intervention group experienced an earlier and steeper decline in survival compared with those undergoing early surgical intervention. The difference in survival distributions was statistically significant by log-rank testing (P = 0.039).
A
Fig. 2
Survival stratified by timing of urological intervention
Kaplan–Meier survival curves comparing patients who underwent urological surgical intervention within 6 hours of disease onset (early intervention) and those who received delayed (> 6 hours) or no surgical intervention. Patients in the delayed or non-intervention group exhibited an earlier and steeper decline in survival. The difference between groups was statistically significant by log-rank test (P = 0.039).
Surgical Timing as an Independent Predictor of 28-Day Mortality
The association between surgical timing and 28-day mortality was further evaluated using Cox proportional hazards regression models (Table 3). In the unadjusted model, delayed or absent surgical intervention was associated with an increased risk of death compared with early intervention. This association persisted after adjustment for age and sex.
In the fully adjusted model, which additionally accounted for diabetes mellitus, urinary tract abscess, septic shock, APACHE II score, procalcitonin level, and time from onset to ICU admission, delayed or no surgical intervention was independently associated with a markedly increased risk of 28-day mortality (hazard ratio 24.35, 95% confidence interval 1.28–465.08; P = 0.034). Although the confidence interval was wide—likely reflecting the limited sample size—the direction of the effect was consistent across all models, with increasing adjustment strengthening the observed association.
Abbreviations
APACHE II
Acute Physiology and Chronic Health Evaluation II
CI
confidence interval
HR
hazard ratio
ICU
intensive care unit
IQR
interquartile range
KM
Kaplan–Meier
PSM
propensity score matching
SD
standard deviation
SMD
standardized mean difference
SOFA
Sequential Organ Failure Assessment.
Declarations
Ethics approval and consent to participate
A
The study protocol was reviewed and approved by the Ethics Committee of Yunfu People’s Hospital, Yunfu City, Guangdong Province, China (2025A040). Research conducted on human data was in compliance with the Helsinki Declaration. A
Given the retrospective nature of the study and the use of anonymized clinical data, the requirement for written informed consent was waived by the ethics committee. Clinical trial number: not applicable.Consent for publication
Not applicable.
A
Data Availability
The datasets generated and/or analyzed during the current study are not publicly available due to institutional and privacy restrictions but are available from the corresponding authors on reasonable request.
Competing interests
The authors declare that they have no competing interests.
A
Funding
This study was supported by the Initiative Project of Clinical Research of Southern Medical University (Grant No. 2023CR018). The funding source had no role in the study design; data collection, analysis, or interpretation; manuscript preparation; or the decision to submit the manuscript for publication.
A
Author Contribution
Y.O. and H.L. contributed equally to this work and are co–first authors. Y.O. and H.L. conceived and designed the study, collected clinical data, and wrote the first draft of the manuscript. S.C., G.L., W.L., D.H., and Y.L. participated in data collection, data verification, and interpretation of clinical findings. Z.Z. and G.G. supervised the study design and implementation, provided critical revisions for important intellectual content, and served as co–corresponding authors. All authors reviewed and approved the final manuscript.
A
Acknowledgement
The authors would like to thank the clinical staff of the Department of Critical Care Medicine and the Department of Urology at Yunfu People’s Hospital for their support in patient care and data collection.
Electronic Supplementary Material
Below is the link to the electronic supplementary material
References
1.
Tandogdu Z, Wagenlehner FM. Global epidemiology of urinary tract infections. Current opinion in infectious diseases. 2016;29(1):73–9.
2.
Wagenlehner FM, Pilatz A, Weidner W. Urosepsis–from the view of the urologist. International journal of antimicrobial agents. 2011;38 Suppl:51 – 7.
3.
De Waele JJ, Girardis M, Martin-Loeches I. Source control in the management of sepsis and septic shock. Intensive care medicine. 2022;48(12):1799–802.
4.
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive care medicine. 2021;47(11):1181–247.
5.
De Waele JJ. Importance of timely and adequate source control in sepsis and septic shock. Journal of intensive medicine. 2024;4(3):281–6.
6.
Reitz KM, Kennedy J, Li SR, Handzel R, Tonetti DA, Neal MD, et al. Association Between Time to Source Control in Sepsis and 90-Day Mortality. JAMA surgery. 2022;157(9):817–26.
7.
Kim H, Chung SP, Choi SH, Kang GH, Shin TG, Kim K, et al. Impact of timing to source control in patients with septic shock: A prospective multi-center observational study. Journal of critical care. 2019;53:176–82.
8.
Kamei J, Sugihara T, Yasunaga H, Matsui H, Sasabuchi Y, Fujimura T, et al. Impact of early ureteral drainage on mortality in obstructive pyelonephritis with urolithiasis: an analysis of the Japanese National Database. World journal of urology. 2023;41(5):1365–71.
9.
Kayano S, Yanagisawa T, Yata Y, Miyajima K, Hara S, Iwatani K, et al. Impact of timing of urinary drainage on clinical outcomes in patients with obstructive pyelonephritis associated with upper urinary tract stones: a propensity score-matched analysis. World journal of urology. 2024;42(1):147.
10.
Ku NS, Lee Y, Park DW. Appropriate timing of antibiotic initiation in patients with sepsis or septic shock: a systematic review and meta-analysis. The Korean journal of internal medicine. 2025;40(5):725–33.
11.
Leung LY, Huang HL, Hung KK, Leung CY, Lam CC, Lo RS, et al. Door-to-antibiotic time and mortality in patients with sepsis: Systematic review and meta-analysis. European journal of internal medicine. 2024;129:48–61.
12.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiolo gy (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296.
13.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Sh ock (Sepsis-3). JAMA.315(8):801–10.