Predicting outcome of patients with severe urinary tract infections admitted via the emergency department

Abstract

Objective: To evaluate clinical prediction tools for making decisions in patients with severe urinary tract infections (UTIs). Methods: This was a retrospective study conducted at 2 hospitals (combined emergency department (ED) census 190,000). Study patients were admitted via the ED with acute pyelonephritis or severe sepsis-septic shock related UTI. Area under the receiver operating characteristic curve (AUROC) augmented by decision curve analysis and sensitivity of each rule for predicting mortality and ICU admission were compared. Results: The AUROC of PRACTICE was greater than that of BOMBARD (0.15 difference, 95% confidence interval [CI] = 0.09–0.22), SIRS (0.21 difference, 95% CI = 0.14–0.28) and qSOFA (0.06 difference, 95% CI = 0–0.11) for predicting mortality. PRACTICE had a greater net benefit compared to BOMBARD and SIRS at all thresholds and a greater net benefit compared to qSOFA between a 1% and 10% threshold probability level for predicting mortality. PRACTICE had a greater net benefit compared to all other scores for predicting ICU admission across all threshold probabilities. A PRACTICE score >75 was more sensitive than a qSOFA score >1 (90% versus 54.3%, 35.7 difference, 95% CI = 24.5–46.9), SIRS criteria >1 (18.6 difference, 95% CI = 9.5–27.7), and a BOMBARD score >2 (12.9 difference, 95% CI = 5–12.9) for predicting mortality. Conclusion: PRACTICE was more accurate than BOMBARD, SIRS, and qSOFA for predicting mortality. PRACTICE had a superior net benefit at most thresholds compared to other scores for predicting mortality and ICU admissions.