Prediction of nosocomial sepsis in neonates by means of a computer-weighted bedside scoring system (NOSEP score)
Prediction of nosocomial sepsis in neonates by means of a computer-weighted bedside scoring system (NOSEP score)
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DOI：
10.1097/00003246-200006000-00058
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发表时间：
2000-06-01
影响因子：
8.8
通讯作者：
Van Acker, KJ
中科院分区：
文献类型：
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作者：
Mahieu, LM;De Muynck, AO;Van Acker, KJ
目的：为了开发一个易于使用的床边评分系统，包括临床变量，血液学变量，感染的危险因素，以预测医院内败血症在新生儿重症监护病房patients.Setting：新生儿重症监护病房在大学医院，安特卫普，Belgium.Patients：超过2年，我们分析了两组患者。首先，我们前瞻性地研究了104次假定的院内败血症在80名新生儿（推导队列），然后我们回顾性地研究了50次在39名新生儿（验证队列）。干预措施：无测量和主要结果：我们开发了两个版本的评分系统来预测院内败血症在患病新生儿。第一个评分系统（NOSEP-1评分）基于15个临床、12个实验室和17个可能与感染相关的历史变量;第二个评分系统（NOSEP-2评分）还包括中心血管导管的培养结果。基于所有独立变量的比值比，在同一中心筛选的39例院内败血症患者队列中开发并验证了加性和加权评分。NOSEP-1评分包括三个实验室变量（C反应蛋白≥ 14 mg/L，血小板减少50%），一个临床因素（发热>38.2 ℃ [100.8 ℉]）和一个风险因素（肠外营养≥ 14天）。NOSEP-2评分由相同变量加上导管座和导管插入部位定植数据组成。受试者工作特征曲线分析表明NOSEP-1评分（曲线下面积[Az] = 0.82 +/- 0.04 [SEMI]）和NOSEP-2评分（Az = 0.84 +/- 0.04，p <0.05）具有良好的预测性能。我们检查了基于NOSEP-1和NOSEP-2中所用项目的原始数值的复杂计算机生成的评分系统（CD-1和CD-2评分）是否会改善对医院内脓毒症的预测。分析显示床旁NOSEP-1和NOSEP-2评分的准确性与更繁琐的计算机生成的CD-1和CD-2评分相当（受试者工作特征曲线，Az：CD-1评分= 0.81 +/- 0.04，p = 0.69，CD-2评分= 0.86 +/- 0.04，p = 0.96）。最后，在验证队列中，我们表明所开发的评分系统对医院内脓毒症具有良好的预测潜力（Hosmer-Lemeshow拟合优度检验，chi（2）[19] = 16.34，p > 0.75）。NOSEP-1简易床旁评分系统包括C反应蛋白、中性粒细胞分数、血小板减少、发热、并且延长的肠外营养暴露为医院内败血症的早期识别提供了有价值的工具。通过将中心血管导管插入部位和导管座定植添加到评分中，可提高其预测能力。
Objective: To develop an easy-to-use bedside scoring system, composed of clinical variables, hematologic variables, and risk factors of infection, to predict nosocomial sepsis in neonatal intensive care unit patients.Setting: A neonatal intensive care unit in a university hospital, Antwerp, Belgium.Patients: Over 2 yrs, we analyzed two groups of patients. First, we prospectively studied 104 episodes of presumed nosocomial sepsis in 80 neonates (derivation cohort), and then we retrospectively studied 50 episodes in 39 neonates (validation cohort).Interventions: None.Measurements and Main Results: We developed two versions of a scoring system to predict nosocomial sepsis in sick neonates. The first scoring system (NOSEP-1 score) was based on 15 clinical, 12 laboratory, and 17 historical variables potentially connected with infection; the second one (NOSEP-2 score) also included the culture results of central vascular catheters. Based on the odds ratios of all independent variables, an additive and weighted score was developed and validated in a cohort of 39 patients screened for nosocomial sepsis in the same center. The NOSEP-1 score consisted of three laboratory variables (C-reactive protein greater than or equal to 14 mg/L, thrombocytopenia 50%), one clinical factor (fever >38.2 degrees C [100.8 degrees F]), and one risk factor (parenteral nutrition for greater than or equal to 14 days). The NOSEP-2 score consisted of the same variables plus catheter-hub and catheter insertion site colonization data. Receiver operating characteristic curve analysis demonstrated good predictor performance of the NOSEP-1 score (area under the curve [Az] = 0.82 +/- 0.04 [SEMI) and NOSEP-2 score (Az = 0.84 +/- 0.04, p < .05). We checked whether a complex computer-generated scoring system (CD-1 and CD-2 scores) based on the original numerical values of the items used in NOSEP-1 and NOSEP-2 would improve the prediction of nosocomial sepsis. The analysis showed the accuracy of bedside NOSEP-1 and NOSEP-2 scores to be comparable with the more cumbersome computer-generated CD-1 and CD-2 scores (receiver operating characteristic curve, Az: CD-1 score = 0.81 +/- 0.04, p = .69, and CD-2 score = 0.86 +/- 0.04, p = .96). Finally, in the validation cohort, we showed that the developed scoring system has a good prediction potential for nosocomial sepsis (Hosmer-Lemeshow goodness-of-fit test, chi(2) [19] = 16.34, p > .75).Conclusions: The simple bedside scoring system NOSEP-1 composed of C-reactive protein, neutrophil fraction, thrombocytopenia, fever, and prolonged parenteral nutrition exposure provides a valuable tool for early identification of nosocomial sepsis. Its predictive power can be improved by adding central Vascular catheter insertion site and hub colonization to the score.