Predictive scoring model of mortality in Gram‐negative bloodstream infection. (27th November 2012)

• Record Type: Journal Article
• Authors: Al‐Hasan, M. N.; Lahr, B. D.; Eckel‐Passow, J. E.; Baddour, L. M.; Paul, M.
• Is Part Of: Clinical microbiology and infection. Volume 19:Number 10(2013:Oct.)
• Page Start: 948
• Page End: 954
• Publication Date: 2012-11-27
• Subjects: Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1111/1469-0691.12085
• Languages: English
• ISSNs: 1198-743X

Abstract

<abstract abstract-type="main" id="clm12085-abs-0001"> <title>Abstract</title> <p>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 28 days 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 (OR 3.48, 95% CI 1.94–6.22), liver cirrhosis (OR 5.42, 95% CI 2.52–11.65), source of BSI other than urinary tract or central venous catheter infection (OR 5.54, 95% CI 2.42–12.69), and PBS (OR 1.98, 95% CI 0.92–4.25 for PBS of 2–3 and OR 6.42, 95% CI 3.11–13.24 for PBS ≥4) 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 <italic>c</italic>‐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.</p> </abstract>