Predictive scoring model of mortality in Gram-negative bloodstream infection
Predictive scoring model of mortality in Gram-negative bloodstream infection
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DOI：
10.1111/1469-0691.12085
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发表时间：
2013-10-01
影响因子：
14.2
通讯作者：
Baddour, L. M.
中科院分区：
文献类型：
--
作者：
Al-Hasan, M. N.;Lahr, B. D.;Baddour, L. M.
死亡率是革兰氏阴性血流感染（BSI）的公认并发症。本研究的目的是开发一个模型，通过使用皮特菌血症评分（PBS）和其他临床和实验室变量来预测革兰氏阴性BSI患者的死亡率。回顾性确定了一组683例从2001年1月1日至2006年10月31日在马约诊所医院住院后至少随访28天的革兰氏阴性BSI患者，这些患者接受了临床预先确定的适当经验性抗菌治疗。多变量logistic回归用于确定28天全因死亡率的独立危险因素。采用多变量模型的回归系数建立风险评分，预测革兰氏阴性BSI后的死亡率。恶性肿瘤（OR 3.48，95%CI 1.94 -6.22），肝硬化（OR 5.42，95%CI 2.52 -11.65），BSI来源，非尿路或中心静脉导管感染（OR5.54，95%CI2.42-12.69）和PBS（OR1.98，95%CI0.92-4.25，PBS为2-3; OR6.42，95%CI3.11-13.24，PBS为4）被确定为革兰氏阴性BSI患者28天死亡率的独立危险因素。通过为每个独立的风险因素添加点来创建风险评分模型，其c-统计量为0.84。风险评分为0、4、8、12和16的患者估计28天死亡率分别约为0%、3%、14%、45%和81%。本文所述的革兰氏阴性BSI风险评分在接受临床上充分的经验性抗菌治疗的革兰氏阴性BSI患者中以高区分度估计死亡风险。
Mortality is a well-recognized complication of Gram-negative bloodstream infection (BSI). The aim of this study was to develop a model to predict mortality in patients with Gram-negative BSI by using the Pitt bacteraemia score (PBS) and other clinical and laboratory variables. A cohort of 683 unique adult patients who were followed for at least 28days after admission to Mayo Clinic Hospitals with Gram-negative BSI from 1 January 2001 to 31 October 2006 and who received clinically predefined appropriate empirical antimicrobial therapy was retrospectively identified. Multivariable logistic regression was used to identify independent risk factors for 28-day all-cause mortality. Regression coefficients from a multivariable model were used to develop a risk score to predict mortality following Gram-negative BSI. Malignancy (OR3.48, 95%CI1.94-6.22), liver cirrhosis (OR5.42, 95%CI2.52-11.65), source of BSI other than urinary tract or central venous catheter infection (OR5.54, 95%CI2.42-12.69), and PBS (OR1.98, 95%CI0.92-4.25 for PBS of 2-3 and OR6.42, 95%CI3.11-13.24 for PBS4) were identified as independent risk factors for 28-day mortality in patients with Gram-negative BSI. A risk-score model was created by adding points for each independent risk factor, and had a c-statistic of 0.84. Patients with risk scores of 0, 4, 8, 12 and 16 had estimated 28-day mortality rates of approximately 0%, 3%, 14%, 45%, and 81%, respectively. The Gram-negative BSI risk score described herein estimated mortality risk with high discrimination in patients with Gram-negative BSI who received clinically adequate empirical antimicrobial therapy.