Comparison of severity of illness scoring systems for patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa.
BACKGROUND
Several acute illness severity scores have been proposed for evaluating patients on admission to intensive care units but these have not been compared for patients with nosocomial bloodstream infection (nBSI). We compared three severity of illness scoring systems for predicting mortality in patients with nBSI due to Pseudomonas aeruginosa.


METHODS
We performed a historical cohort study on 63 adults in intensive care units with P. aeruginosa monomicrobial nBSI.


RESULTS
The Acute Physiology, Age, Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiologic Score (SAPS II), were calculated daily from 2 days prior through 2 days after the first positive blood culture. Calculation of the area under the receiver operating characteristic (ROC) curve confirmed that APACHE II and SAPS II at day -1 and SOFA at day +1 were better predictors of outcome than days -2, 0 and day 2 of BSI. By stepwise logistic regression analysis of these three scoring systems, SAPS II (OR: 13.03, CI95% 2.51-70.49) and APACHE II (OR: 12.51, CI95% 3.12-50.09) on day -1 were the best predictors for mortality.


CONCLUSIONS
SAPS II and APACHE II are more accurate than the SOFA score for predicting mortality in this group of patients at day -1 of BSI.
Marra
Alexandre R
AR
Division of Infectious Diseases, Universidade Federal de São Paulo, Brasil (UNIFESP-EPM)/Hospital São Paulo (HSP), Brazil. a.marra@uol.com.br
Bearman
Gonzalo M L
GM
Wenzel
Richard P
RP
Edmond
Michael B
MB
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology*; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology*; D011550:Pseudomonas aeruginosa; D012372:ROC Curve; D012720:Severity of Illness Index