Derivation of a quick Pitt bacteremia score to predict mortality in patients with Gram-negative bloodstream infection

被引:53
作者
Battle, Sarah E. [1 ]
Augustine, Matthew R. [2 ]
Watson, Christopher M. [3 ]
Bookstaver, P. Brandon [4 ,5 ]
Kohn, Joseph [5 ]
Owens, William B. [1 ,2 ]
Baddour, Larry M. [6 ]
Al-Hasan, Majdi N. [1 ,2 ]
机构
[1] Univ South Carolina, Palmetto Hlth, Med Grp, Dept Med, Columbia, SC 29208 USA
[2] Univ South Carolina, Sch Med, 2 Med Pk,Suite 502, Columbia, SC 29203 USA
[3] Prisma Hlth Richland Hosp, Dept Acute Care Surg, Columbia, SC USA
[4] Univ South Carolina, Coll Pharm, Dept Clin Pharm & Outcomes Sci, Columbia, SC 29208 USA
[5] Prisma Hlth Richland Hosp, Dept Pharm, Columbia, SC USA
[6] Mayo Clin, Dept Med, Div Infect Dis, Rochester, MN USA
关键词
Bacteremia; Sepsis; Antibiotics; Outcomes; Survival; INTERNATIONAL CONSENSUS DEFINITIONS; EMPIRICAL ANTIMICROBIAL THERAPY; ORGAN FAILURE ASSESSMENT; IN-HOSPITAL MORTALITY; PROGNOSTIC ACCURACY; SUSPECTED INFECTION; RISK SCORE; SEPSIS; CRITERIA; STRATIFICATION;
D O I
10.1007/s15010-019-01277-7
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
PurposeThis retrospective cohort study derived a quick version of the Pitt bacteremia score (qPitt) using binary variables in patients with Gram-negative bloodstream infections (BSI). The qPitt discrimination was then compared to quick sepsis-related organ failure assessment (qSOFA) and systemic inflammatory response syndrome (SIRS).MethodsHospitalized adults with Gram-negative BSI at Palmetto Health hospitals in Columbia, SC, USA from 2010 to 2013 were identified. Multivariate Cox proportional hazards regression was used to determine variables associated with 14-day mortality.ResultsAmong 832 patients with Gram-negative BSI, median age was 65years and 449 (54%) were women. After adjustments for age and Charleston comorbidity score, all five components of qPitt were independently associated with mortality: temperature<36 degrees C [hazard ratio (HR) 3.02, 95% confidence interval (CI) 1.95-4.62], systolic blood pressure<90mmHg or vasopressor use (HR 2.40, 95% CI 1.37-4.13), respiratory rate >= 25/min or mechanical ventilation (HR 3.01, 95% CI 1.81-5.14), cardiac arrest (HR 5.35, 95% CI 2.81-9.43), and altered mental status (HR 3.99, 95% CI 2.44-6.80). The qPitt had higher discrimination to predict mortality [area under receiver operating characteristic curve (AUROC) 0.85] than both qSOFA (AUROC 0.77, p<0.001) and SIRS (AUROC 0.63, p<0.001). There was a significant difference in mortality between appropriate and inappropriate empirical antimicrobial therapy in patients with qPitt >= 2 (24% vs. 49%, p<0.001), but not in those with qPitt<2 (3% vs. 5%, p=0.36).ConclusionsThe qPitt had good discrimination in predicting mortality following Gram-negative BSI and identifying opportunities for improved survival with appropriate empirical antimicrobial therapy.
引用
收藏
页码:571 / 578
页数:8
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