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

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.

Prognostic Accuracy of the qSOFA Score for In-Hospital Mortality in Elderly Patients with Obstructive Acute Pyelonephritis: A Multi-Institutional Study

“…Finally, in the current study, the rate of in-hospital mortality was 7%, which appears to be relatively high. This is, however, nearly equivalent to the rate in previous studies [ 25 , 26 ].…”

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

“…In the comparison between CRB and CRB-65, despite the addition of age as a parameter, CRB-65 was statistically superior only in predicting in-hospital mortality (p = 0.02). In previous studies that compared the effectiveness of prediction by qSOFA and SIRS in UTI patients, qSOFA had a higher predictive accuracy for in-hospital mortality and ICU admissions than SIRS [25,26]. Likewise, in our study, the ability of qSOFA to identify the requirement of ICU admission and in-hospital mortality in patients with UTI was better than that of SIRS.…”

COVID-19 pandemic impact on clinical outcomes of patients with obstructive pyelonephritis

“…These patients presented higher rates of clinically significant complications (Clavien ≥ 2), with a total of 6 (26%) cases. Historically, hospital lengths of stay of patients with OPN vary from 4.25 to 12 days [22,27,1]. This study demonstrated that patients from the Post-Covid group had a significantly higher length of stay when compared to the Pre-Covid group (7.6 vs. 3.8 days; p = 0.007), possibly due to the higher Clavien ≥ 2 complication rates in the first group.…”

“…Obstructive pyelonephritis (OPN) is a very common clinical condition in urological practice [1], with high rates of sepsis and Intensive Care Unit (ICU) admissions [2,3], leading to prolonged hospital length of stay and an overall mortality of 2% [4,5]. Obstructive pyelonephritis is an emergency, where targeted treatment [6,7] and prompt decompression of the collecting system [8,9] can potentially improve clinical outcomes, with a high impact on patient morbidity and mortality [10,11].…”