Urosepsis Definition
Urosepsis is defined as life-threatening organ dysfunction resulting from a dysregulated host response to a urogenital tract infection, clinically identified by an increase in Sequential Organ Failure Assessment (SOFA) score of 2 points or more. 1
Core Clinical Definition
Urosepsis represents sepsis originating specifically from the urogenital tract, distinguishing it from other sepsis sources. 2 This follows the Sepsis-3 consensus criteria that emphasizes organ dysfunction rather than simple infection with systemic inflammation. 2
Key Diagnostic Criteria
The diagnosis requires two components:
- Confirmed or suspected urogenital tract infection as the source 2
- Evidence of organ dysfunction demonstrated by SOFA score increase of ≥2 points from baseline 1, 2
Rapid Bedside Identification: qSOFA Score
For rapid identification at the bedside, use the quick SOFA (qSOFA) score, which includes three simple criteria: 1, 2
- Respiratory rate ≥22 breaths/minute
- Altered mental status
- Systolic blood pressure ≤100 mmHg
The presence of two or more qSOFA criteria should trigger immediate concern for sepsis and prompt further evaluation. 2
Clinical Context and Underlying Infections
Urosepsis almost exclusively develops from complicated urinary tract infections involving parenchymatous urogenital organs such as the kidneys and prostate, not simple cystitis. 3, 4 The condition accounts for approximately 25% of all sepsis cases. 5, 3
The most common underlying cause is obstructed uropathy of the upper urinary tract, with ureterolithiasis being the predominant etiology. 4
Septic Shock Progression
Septic shock represents the most severe form, defined by: 2
- Persistent hypotension (systolic blood pressure <90 mmHg or mean arterial pressure <65 mmHg) despite adequate fluid resuscitation, OR
- Lactate >4 mmol/L after fluid resuscitation
This subset carries substantially increased mortality due to profound circulatory and cellular/metabolic abnormalities. 2
Critical Prognostic Information
Even with optimal treatment, mortality remains approximately 10% for urosepsis and 30-40% for septic shock, making early recognition absolutely critical. 2, 4 In community-onset urosepsis specifically, 30-day mortality is approximately 14%. 6
Important Diagnostic Pitfalls
Do not use SIRS (Systemic Inflammatory Response Syndrome) criteria for sepsis classification, as the Sepsis-3 guidelines discontinued this approach, though SIRS remains useful as a screening tool only. 2 The modern definition prioritizes organ dysfunction over inflammatory markers alone.
The full SOFA score should be assessed when systemic symptoms of sepsis are present, not just the abbreviated qSOFA. 1 Both scoring systems serve complementary roles in diagnosis and risk stratification.