Development of an emergency department risk score for in-hospital mortality in elderly patients with urinary tract infection
Abstract
BACKGROUND
Urinary tract infection (UTI) is among the most prevalent bacterial infections globally, particularly impacting elderly populations in emergency departments (EDs). This study aimed to develop and validate an ED-specific risk score predicting in-hospital mortality for elderly patients with UTI.
METHODS
Using data from the MIMIC-IV-ED database, we enrolled patients aged 65 or older with confirmed UTI admitted to wards or ICUs. Variables were selected through stepwise logistic regression using Bayesian Information Criterion in the derivation cohort (70 %), and dichotomized by optimal cut-offs identified by Youden's index. A point-based scoring system was developed from regression coefficients. Internal validation was performed on a separate validation cohort (30 %) assessing discrimination (AUC), calibration, and clinical utility using decision curve analysis.
RESULTS
Among 2391 patients, 160 (6.7 %) experienced in-hospital mortality. The EARL-UTI score included five variables: age >83 years, Emergency Severity Index 15.7 %, albumin 2.4 mmol L-1. Scores ≥4 predicted a mortality rate of 29.9 % compared to 4.5 % in lower-scoring groups, with sensitivity and specificity of 59.6 % and 93.1 %, respectively, and a negative predictive value of 95.5 %. Validation cohort performance remained consistent (AUC 0.73), and the model outperformed established risk scores.
CONCLUSIONS
The EARL-UTI score provides an easily implemented bedside tool for rapid identification of elderly…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 2,391 participants or records.
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