Investig Clin Urol.  2019 Mar;60(2):120-126. 10.4111/icu.2019.60.2.120.

Quick Sequential (Sepsis related) Organ Failure Assessment: A high performance rapid prognostication tool in patients having acute pyelonephritis with upper urinary tract calculi

Affiliations
  • 1Department of Urology, King George's Medical University, Lucknow, India. sankhwarsn.sn@gmail.com
  • 2Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Abstract

PURPOSE
To analyze the utility of quick Sequential Organ Failure Assessment (qSOFA) in patients with uro-sepsis due to acute pyelonephritis (APN) with upper urinary tract calculi, we conducted this study. The role of qSOFA as a tool for rapid prognostication in patients with sepsis is emerging. But there has been a great debate on its utility. Literature regarding utility of qSOFA in uro-sepsis is scarce.
MATERIALS AND METHODS
Ours was a retrospective study including 162 consecutive patients who were admitted for APN with upper urinary tract calculi over a 3 and half years (total 42 months) period. We evaluated the accuracy of qSOFA in predicting inhospital mortality and intensive care unit (ICU) admissions and compared this with the predictive accuracy of systemic inflammatory response syndrome (SIRS). We used the Area Under Curve (AUC) of the Receiver Operator Characteristic curve to calculate it and also calculated the optimum cut off for qSOFA score.
RESULTS
The overall mortality and ICU admission rates were 7.4% and 12.9%, respectively. qSOFA had a higher predictive accuracy for in-hospital mortality (AUC, 0.981; 95% confidence interval [CI], 0.962-1.000) and ICU admissions (AUC, 0.977; 95% CI, 0.955-0.999) than SIRS. A qSOFA score of ≥2 was an optimum cut off for predicting prognosis. In a multivariate model qSOFA ≥2 was a highly significant predictor of in-hospital mortality and ICU admissions (p < 0.001).
CONCLUSIONS
qSOFA is a reliable and rapid bedside tool in patients with sepsis with accuracy more than SIRS in predicting inhospital mortality and ICU admissions.

Keyword

Hospital mortality; Pyelonephritis; Sepsis; Urinary tract infection; Urolithiasis

MeSH Terms

Area Under Curve
Calculi*
Hospital Mortality
Humans
Intensive Care Units
Mortality
Prognosis
Pyelonephritis*
Retrospective Studies
Sepsis
Systemic Inflammatory Response Syndrome
Urinary Tract Infections
Urinary Tract*
Urolithiasis

Figure

  • Fig. 1 Distribution of patient mortality according to quick Sequential Organ Failure Assessment (qSOFA) score.

  • Fig. 2 Distribution of intensive care unit (ICU) admission according to quick Sequential Organ Failure Assessment (qSOFA) score.

  • Fig. 3 qSOFA (AUC, 0.981; 95% CI, 0.962–1.000) and SIRS (AUC, 0.924; 95% CI, 0.860–0.989) ROC curves for in-hospital mortality on top and qSOFA (AUC, 0.977; 95% CI, 0.955–0.999) and SIRS (AUC, 0.860; 95% CI, 0.792–0.928) ROC curves for ICU admissions on the bottom. qSOFA, quick Sequential Organ Failure Assessment; AUC, area under curve; CI, confidence interval; SIRS, systemic inflammatory response syndrome; ROC, receiver operating characteristic; ICU, intensive care unit.


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