title: Predictive scoring model of mortality in Gram-negative bloodstream infection.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Kentucky, Lexington, KY, USA; Department of Medicine, Division of Infectious Diseases, College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: M N
authors.initials: MN
authors.lastname: Al-Hasan
authors.forename: B D
authors.initials: BD
authors.lastname: Lahr
authors.forename: J E
authors.initials: JE
authors.lastname: Eckel-Passow
authors.forename: L M
authors.initials: LM
authors.lastname: Baddour
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000401:mortality*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015233:Models, Statistical; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors