Clinical characteristics and prognosis in patients with urosepsis from intensive care unit in Shanghai, China: a retrospective bi-centre study

Abstract

Background The purpose of this study was to retrospectively analyze clinical characteristics and prognostic risk factors of urosepsis patients admitted to two intensive care units in Shanghai, China. Methods Clinical data from patients diagnosed with urosepsis were retrospectively retrieved and analyzed from ICU in two regional medical centers from January 2015 to December 2019. Results Two hundred two patients were included in the subsequent analysis eventually, with an average age of 72.02 ± 9.66 years, 79.21% of the patients were female and the mortality rate of 15.84%.The proportion of patients with chronic underlying diseases such as diabetes and hypertension was relatively high (56.44, 49.50%, respectively), and the incidence of shock was also high (41.58%) correspondingly. The most common pathogen isolated was Escherichia coli (79.20%), of which the extended-spectrumβ-lactamases (ESBLs)(+) accounted for 42.57%. In multivariate analysis, the strongest predictors for death were mechanical ventilation (OR 7.260, 95% CI 2.200–23.963; P = 0.001),chronic kidney disease (CKD) (OR 5.140, 95% CI 1.596–16.550; P = 0.006), APACHE II score (OR 1.321, 95% CI 1.184–1.473; P < 0.001) and lactate (OR 1.258, 95% CI 1.037–1.527; P = 0.020). Both APACHE II score and lactate had the ideal predictive value, with the area under the ROC curve (AUC) of 0.858 and 0.805 respectively. Conclusion The patients with urosepsis were characterized by a higher proportion of female, older age, more percentage of comorbidities in this region, and patients with ESBLs (+) Escherichia coli infection were more prone to shock. Mechanical ventilation, comorbidity with CKD, APACHE II score and lactate were independent risk factors for death in urosepsis patient, but lactate level and APACHE II score had better predictive value for prognosis.

Retrospective Study of the Etiology, Laboratory Findings, and Management of Patients with Urinary Tract Infections and Urosepsis from a Urology Center in Silesia, Southern Poland Between 2017 and 2020

“…The median age of our patients (67 years) was identical with the Canadian survey; although, in our study, most patients were male [ 24 ]. In a 2-center study from China, the age structure of patients was similar to that of our present study, but the number of women affected was higher [ 25 ]. It is also interesting that, in contrast to our study in which the most common urological comorbidity disease was hydronephrosis (due to the dysfunction of urinary drainage), in the case of the study from China, it was urolithiasis [ 25 ].…”

“…In a 2-center study from China, the age structure of patients was similar to that of our present study, but the number of women affected was higher [ 25 ]. It is also interesting that, in contrast to our study in which the most common urological comorbidity disease was hydronephrosis (due to the dysfunction of urinary drainage), in the case of the study from China, it was urolithiasis [ 25 ]. A study from Ireland showed a similar average age (70 years) and more female patients (60%) [ 28 ].…”

“…In a single-center study in Canada, the results were significantly lower, although a similar methodology was used [ 24 ]. A recent study from China confirmed an even more frequent occurrence of the above strains, at the level of 42% [ 25 ]. Interestingly, the percentage of E.coli was much lower than in a similar study from India (44% vs 94%), but this is most likely due to the different identification methods used [ 26 ].…”

Diagnostic and therapeutic value of biomarkers in urosepsis

“…In urosepsis patients, organ function and Lac clearance are impaired, which also leads to elevated serum Lac. 71 Lac is an independent risk factor for death in patients with urosepsis 20 and is closely related to patient prognosis. Lac levels have long been used in sepsis screening and management to help physicians make clinical decisions.…”

Asymptomatic Bacteriuria or Urinary Tract Infection? New and Old Biomarkers

“…An inappropriate antibiotic therapy increases the risk of antibiotic resistance [4], and it is a financial burden for the community [5]. Conversely, a delay of an appropriate treatment could impact patient conditions, considering that mortality rates due to urosepsis can be as high as 16% [6]. Consequently, there is a strong need for biomarkers able to ease the clinical diagnosis of UTIs.…”