Evaluation Of Five Scoring Systems For Predicting ICU Admission In Patients With Urosepsis

Objective: This study analyzed the general characteristics of urosepsis patients with ICU admission needs and evaluated the value of SOFA,qSOFA,APACHE II,LODS,and m Marshall score in predicting ICU admission in urosepsis patients.Materials and Methods: The patients with urosepsis who met the SIRS from January2018 to January 2021 were retrospectively analyzed.The patients were divided into ICU group and non-ICU group according to whether they were admitted to the ICU or not.The clinical data of the patients were extracted and the SOFA,qSOFA,APACHE II,LODS and m Marshall scores were calculated.The differences in the general conditions and laboratory tests between the two groups were analyzed to identify the related factors that may affect the patient’s condition;the correlation between different scoring systems and ICU admission of patients with urosepsis was evaluated to understand the feasibility of different scoring systems as predictive indicators;the ROC curves of the five scoring systems for predicting ICU admission of patients with urosepsis were drawn to compare the AUC,optimal cut-off value and sensitivity and specificity of different scoring systems,to find the scoring system with the highest predictive titer,and to evaluate its value for predicting ICU admission of patients with urosepsis.The correlation between inflammatory parameters and the optimal scoring system was analyzed,and the quantitative relationship between inflammatory parameters and the optimal scoring system and ICU admission in patients with urosepsis was further analyzed by Logistic regression analysis.Results: 1.Compared with non-ICU group,patients requiring ICU admission only had differences in respiration,mental status and hypotension in general conditions(p < 0.05);there were significant differences in white blood cell,C-reactive protein,carbon dioxide binding capacity,INR and urine culture results in serological indicators(p < 0.05);there were significant differences in neutrophil ratio,platelets,procalcitonin,albumin,creatinine and glomerular filtration rate between the two groups(p < 0.001);there were significant differences in the five scoring systems between the two groups(p < 0.05);2.The five scoring systems were correlated with the need for ICU admission in patients with urosepsis,and the AUCs from largest to smallest were SOFA(0.924),LODS(0.871),m Marshall(0.843),APACHE II(0.745)and qSOFA(0.716),respectively.Comparing the AUC between SOFA score and the other four scores,the predictive potency of SOFA score was better than that of the other four scores,and the difference had statistical significance(p < 0.05);3.SOFA score was positively correlated with white blood cells(r = 0.38,p < 0.001),neutrophil ratio(r = 0.429,p < 0.001),C-reactive protein(r = 0.345,p = 0.001),and procalcitonin(r = 0.461,p < 0.001);Logistic regression showed that SOFA score was an independent risk factor for ICU admission requirement in urosepsis patients(β = 0.785,OR = 2.192,95% CI 1.514 –3.172,p < 0.001).Conclusion: Compared with the non-ICU group,patients with urosepsis requiring ICU admission were more likely to have shortness of breath,mental changes,and hypotension,and tended to have worse inflammatory parameters and serological markers related to organ function.All five scoring systems,SOFA,qSOFA,APACHE II,LODS,and m Marshall,predicted the need for ICU admission in patients with urosepsis,with the SOFA score predicting the best titer.Both inflammatory measures and SOFA scores reflected the severity of urosepsis condition,but SOFA scores had a better correlation in predicting the need for ICU admission.For patients with urosepsis,each1-point increase in SOFA score increases the risk of ICU admission by approximately2-fold;when SOFA score is > 4,patients should be considered for further ICU treatment to improve patient prognosis.