Predictive Value of Inflammatory Markers Combined With Urinary Biomarkers for 28-Day Outcomes in Patients With Urosepsis: A Retrospective Study.

Abstract

Background: Urosepsis is a life-threatening complication of urinary tract infection (UTI) associated with high mortality. Early identification of patients at high risk of poor outcomes remains challenging due to the limited predictive value of single biomarker.

Methods: We retrospectively analysed 148 patients with urosepsis admitted to Tianjin Medical University General Hospital between October 2022 and October 2025. Baseline clinical characteristics, laboratory markers (high-sensitivity C-reactive protein [hsCRP], procalcitonin [PCT], serum creatinine [Scr], β2-microglobulin [β2-MG], and urinary orosomucoid-to-creatinine ratio [u-ORM/u-CREAT]) and 28-day outcomes were collected. Patients were classified into favourable prognosis (n = 102) and poor prognosis (n = 46) groups. Between-group differences were analysed using appropriate parametric, nonparametric, or categorical tests. Prognostic factors were evaluated by univariate and multivariable logistic regression, and predictive performance was assessed by receiver operating characteristic (ROC) curve analysis.

Results: The levels of hsCRP, PCT, Scr, β2-MG, and u-ORM/u-CREAT were significantly higher in the poor prognosis group than in the favourable prognosis group (all p < 0.001). Multivariable analysis identified hsCRP >85.3 mg/L, PCT >5.7 ng/mL, Scr >132 μmol/L, and u-ORM/u-CREAT >18.5 mg/mmol as independent predictors of poor prognosis (all p < 0.05). A combined model of hsCRP, PCT, Scr, and u-ORM/u-CREAT achieved the highest predictive performance, with an area under the ROC curve of 0.923, a sensitivity of 86.9% and a specificity of 84.3%, and outperformed individual marker (all p < 0.05).

Conclusions: Combined assessment of hsCRP, PCT, Scr, and u-ORM/u-CREAT showed high predictive value for poor 28-day clinical outcomes in urosepsis and may support early risk stratification.