title: Development and Validation of a Clinical Prediction Rule for Bacteremia among Maintenance Hemodialysis Patients in Outpatient Settings.
abstract: BACKGROUND
  To our knowledge, no reliable clinical prediction rule (CPR) for identifying bacteremia in hemodialysis (HD) patients has been established. The aim of this study was to develop a CPR for bacteremia in maintenance HD patients visiting the outpatient department.
  
  
  METHODS
  This multicenter cohort study involved consecutive maintenance HD patients who visited the outpatient clinic or emergency room of seven Japanese institutions between August 2011 and July 2013. The outcome measure was bacteremia diagnosed based on the results of blood cultures. The candidate predictors for bacteremia were extracted through a literature review. A CPR for bacteremia was developed using a coefficient-based multivariable logistic regression scoring method, and calibration was performed. The test performance was then assessed for the CPR.
  
  
  RESULTS
  Of 507 patients eligible for the study, we analyzed the 293 with a complete dataset for candidate predictors. Of these 293 patients, 48 (16.4%) were diagnosed with bacteremia. At the conclusion of the deviation process, body temperature ≥ 38.3°C, heart rate ≥ 125 /min, C-reactive protein ≥ 10 mg/dL, alkaline phosphatase >360 IU/L, and no prior antibiotics use within the past week were retained and scored. The CPR had a good fit for the model on calibration. The AUC of the CPR was 0.76, and for score CPR ≥ 2, the sensitivity and specificity were 89.6% and 51.4%, respectively.
  
  
  CONCLUSIONS
  We established a simple CPR for bacteremia in maintenance HD patients using routinely obtained clinical information in an outpatient setting. This model may facilitate more appropriate clinical decision making.
authors.affiliation: Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, JAPAN.|Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, JAPAN.|Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, JAPAN.
authors.forename: Sho
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, JAPAN.|Office for Promoting Medical Research, Showa University, Tokyo, JAPAN.|Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, JAPAN.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Inagi Municipal Hospital, Inagi, JAPAN.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Kawarazaki
authors.affiliation: Department of Immunology, Juntendo University School of Medicine, Tokyo, JAPAN.|Department of Nephrology, Chubu Rosai Hospital, Nagoya, JAPAN.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nomura
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Inagi Municipal Hospital, Inagi, JAPAN.|Department of Nephrology and Hypertension, Kawasaki Municipal Tama Hospital, Kawasaki, JAPAN.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Uchida
authors.affiliation: Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, JAPAN.|Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, JAPAN.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Imaizumi
authors.affiliation: Department of Nephrology, Aso Iizuka Hospital, Iizuka, JAPAN.
authors.forename: Masahide
authors.initials: M
authors.lastname: Furusho
authors.affiliation: Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, JAPAN.|Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, JAPAN.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nishiwaki
authors.affiliation: Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, JAPAN.|Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, JAPAN.
authors.forename: Shingo
authors.initials: S
authors.lastname: Fukuma
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, JAPAN.
authors.forename: Yugo
authors.initials: Y
authors.lastname: Shibagaki
authors.affiliation: Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, JAPAN.|Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, JAPAN.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000032:analysis; D019540:Area Under Curve; D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology; D001831:Body Temperature; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006339:Heart Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D016015:Logistic Models; D008297:Male; D010045:Outpatients; D012372:ROC Curve; D006435:Renal Dialysis / Q000379:methods*; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D002097:C-Reactive Protein; D000469:Alkaline Phosphatase