Clinical Characteristics of Patients with Urosepsis: A Descriptive Study Based on the MIMIC-IV Database

Abstract

Objective This study aimed to compare the clinical characteristics of urosepsis patients with those having other types of sepsis, extract key clinical insights, and identify potential future research avenues. Material and Methods Data from 32,971 anonymized records in the MIMIC-IV database were analyzed. Among these, 6,141 patients met the inclusion criteria for sepsis. A comparative analysis was conducted, followed by univariate and multivariate Cox regression analyses to assess in-hospital mortality. Results The analysis included 1,418 urosepsis patients and 4,723 non-urosepsis patients. Urosepsis predominantly affected older individuals, particularly women, with a higher prevalence of comorbidities such as myocardial infarction, congestive heart failure, renal disease, severe liver disease, diabetes mellitus, and AIDS. Laboratory evaluations indicated lower white blood cell counts, neutrophil levels, and neutrophil-to-lymphocyte ratios (NLR) in urosepsis patients. The main pathogens in urosepsis were gram-negative bacteria (44.0%) and fungi (21.9%), whereas non-urosepsis was mainly caused by Gram-positive bacteria (57.2%). Regression analysis showed advanced age and elevated lactate levels as significant predictors of in-hospital mortality in urosepsis. The use of vasoactive agents appeared to improve prognosis. Current SOFA and SAPS II scores are inadequate for evaluating urosepsis severity. Conclusions Urosepsis is characterized by a higher prevalence in women, older age, and more comorbidities. Organ failure is less severe than in other sepsis types, resulting in a relatively improved prognosis. Advanced age and elevated lactate levels are independent risk factors, while early vasopressor administration may protect urosepsis patients. Current scoring systems have limited applicability to this population.