Comparison of CRB/CRB-65, qSOFA, and SIRS for Risk Prediction in Patients with Urinary Tract Infection

Abstract

Background: Early recognition of sepsis is critical for improving patient outcomes. In approximately 20%-30% of patients, sepsis resulted from urinary tract infection (UTI). This study aimed to investigate the effectiveness of CRB (confusion, respiratory rate, blood pressure), CRB-65, and quick sequential organ failure assessment (qSOFA) in predicting intensive care unit (ICU) admission and in-hospital mortality of patients with UTI and compare them with Systemic Inflammatory Response Syndrome (SIRS). Methods: This retrospective cohort study included patients with UTI who visited the emergency department of a single medical center between February 2018 and March 2020. Baseline characteristic data were obtained and compared with the prevalence of ICU admission and in-hospital mortality. The effectiveness of CRB, CRB-65, qSOFA, and SIRS as indicators of ICU admission and in-hospital mortality was evaluated using the area under the receiver operating characteristic (AUROC) curve. Results: Overall, 1151 patients were included in this study, of whom 132 (11.5%) were admitted to the ICU and 30 (2.6%) succumbed to in-hospital mortality. AUROC values of CRB, CRB-65, and qSOFA as predictors of ICU admission and in-hospital mortality were similar. The CRB score of ≥1 had a sensitivity and specificity of 71.3% and 73.5%, respectively, for ICU admission and 66.7% and 69.2%, respectively, for in-hospital mortality. The CRB-65 score of ≥2 had a sensitivity and specificity of 61.2% and 80.9%, respectively, for ICU admissions and 60% and 76.9%, respectively, for in-hospital mortality. The qSOFA score of ≥1 had a sensitivity and specificity of 71.3% and 79.6%, respectively, for ICU admission and 66.7% and 74.8%, respectively, for in-hospital mortality. Conclusion: CRB, CRB-65, and qSOFA were more effective predictors than SIRS for patients with UTI. CRB, CRB-65, and qSOFA had similar general values for predicting outcomes in patients with UTI in the emergency department.