University College London Hospitals, London, UK.
Division of Surgery and Interventional Science, University College London, Charles Bell Housr, London, UK.
World J Urol. 2024 May 10;42(1):314. doi: 10.1007/s00345-024-04979-2.
To provide a descriptive report of mortality and morbidity in the first 30 days of diagnosis of urosepsis. Secondary aim is to identify risk factors of unfavourable outcomes.
Prospective observational multicentre cohort study conducted from September 2014 to November 2018 in European hospitals. Adult patients (≥ 18 years) diagnosed with acute urosepsis according to Sepsis-2 criteria with confirmed microbiological infection were included. Outcomes were classified in one of four health states: death, multiple organ failure, single organ failure, and recovery at day 30 from onset of urosepsis. Descriptive statistics and ordinal logistic regression analysis was performed.
Three hundred and fifty four patients were recruited, and 30-day mortality rate was 2.8%, rising to 4.6% for severe sepsis. All patients who died had a SOFA score of ≥ 2 at diagnosis. Upon initial diagnosis, 79% (n = 281) of patients presented with OF. Within 30 days, an additional 5% developed OF, resulting in a total of 84% affected. Charlson score (OR 1.14 CI 1.01-1.28), patients with respiratory failure at baseline (OR 2.35, CI 1.32-4.21), ICU admission within the past 12 months (OR 2.05, CI 1.00-4.19), obstruction causative of urosepsis (OR 1.76, CI 1.02-3.05), urosepsis with multi-drug-resistant(MDR) pathogens (OR 2.01, CI 1.15-3.53), and SOFA baseline score ≥ 2 (OR 2.74, CI 1.49-5.07) are significantly associated with day 30 outcomes (OF and death).
Impact of comorbidities and MDR pathogens on outcomes highlights the existence of a distinct group of patients who are prone to mortality and morbidity. These findings underscore the need for the development of pragmatic classifications to better assess the severity of UTIs and guide management strategies.
Clinicaltrials.gov registration number NCT02380170.
描述尿脓毒症诊断后 30 天内的死亡率和发病率。次要目标是确定不良结局的危险因素。
这是一项于 2014 年 9 月至 2018 年 11 月在欧洲医院进行的前瞻性观察性多中心队列研究。纳入符合 Sepsis-2 标准诊断为急性尿脓毒症且有确认的微生物感染的成年患者（≥18 岁）。结局分为以下四种健康状态之一：死亡、多器官衰竭、单器官衰竭和尿脓毒症发病后 30 天恢复。采用描述性统计和有序逻辑回归分析。
共纳入 354 例患者，30 天死亡率为 2.8%，严重脓毒症时上升至 4.6%。所有死亡患者在诊断时 SOFA 评分均≥2。初始诊断时，79%（n=281）的患者存在 OF。30 天内，另外 5%的患者发生 OF，总共有 84%的患者受到影响。Charlson 评分（OR 1.14，95%CI 1.01-1.28）、基线时有呼吸衰竭的患者（OR 2.35，95%CI 1.32-4.21）、过去 12 个月内入住 ICU 的患者（OR 2.05，95%CI 1.00-4.19）、导致尿脓毒症的梗阻（OR 1.76，95%CI 1.02-3.05）、由多药耐药（MDR）病原体引起的尿脓毒症（OR 2.01，95%CI 1.15-3.53）和基线 SOFA 评分≥2（OR 2.74，95%CI 1.49-5.07）与 30 天结局（OF 和死亡）显著相关。
合并症和 MDR 病原体对结局的影响突出了存在一个易发生死亡率和发病率的特定患者群体。这些发现强调需要制定实用的分类方法，以更好地评估尿路感染的严重程度并指导管理策略。
Clinicaltrials.gov 注册号 NCT02380170。
