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 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.

译文

死亡率是公认的革兰氏阴性血流感染 (BSI) 的并发症。这项研究的目的是通过使用Pitt菌血症评分 (PBS) 和其他临床和实验室变量来开发一种模型来预测革兰氏阴性BSI患者的死亡率。回顾性鉴定了683名独特的成年患者,这些患者在2001年1月1日至2006年10月31日期间因革兰氏阴性BSI入院后至少接受了28天的随访,并接受了临床预定义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。来自多变量模型的回归系数用于建立风险评分,以预测革兰氏阴性BSI后的死亡率。恶性肿瘤 (或3.48,95% CI 1.94-6.22),肝硬化 (或5.42,95% CI 2.52-11.65),除泌尿道或中心静脉导管感染以外的BSI来源 (或5.54,95% CI 2.42-12.69) 和PBS (或1.98,PBS 2-3的95% CI 0.92-4.25和OR 6.42,PBS ≥ 4的95% CI 3.11-13.24) 被确定为革兰氏阴性BSI患者28天死亡的独立危险因素。通过为每个独立的风险因素加点来创建风险评分模型,并且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风险评分估计了接受临床上充分经验性抗菌治疗的革兰氏阴性BSI患者的高度歧视的死亡风险。

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