World Journal of Emergency Medicine ›› 2023, Vol. 14 ›› Issue (4): 280-286.doi: 10.5847/wjem.j.1920-8642.2023.067
• Original Article • Previous Articles Next Articles
Xinlei Wang, Yao Sun, Xiaoyu Ni, Shu Zhang()
Received:
2022-11-25
Accepted:
2023-03-28
Online:
2023-06-30
Published:
2023-07-01
Contact:
Shu Zhang
E-mail:164754630@qq.com
Xinlei Wang, Yao Sun, Xiaoyu Ni, Shu Zhang. Development and validation of an emergency bloodstream infection score for predicting in-hospital mortality in patients with community-acquired bloodstream infections[J]. World Journal of Emergency Medicine, 2023, 14(4): 280-286.
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URL: http://wjem.com.cn/EN/10.5847/wjem.j.1920-8642.2023.067
Table 1.
Comparison of baseline data between the modeling and validation groups
Variables | Modeling group (n=440) | Validation group (n=107) | P-value |
---|---|---|---|
Age, year | 57.13±18.63 | 54.25±17.81 | 0.149 |
Sex, male, n (%) | 270 (61.40) | 65 (60.70) | 0.907 |
Vital signs | |||
Temperature, °C | 38.53±1.18 | 38.39±1.38 | 0.338 |
Heart rate, beats/min | 115.85±23.39 | 116.52±29.17 | 0.826 |
Respiratory rate, breaths/min | 25 (21-30) | 24 (20-30) | 0.852 |
Systolic pressure, mmHg | 94.51±16.70 | 93.86±20.46 | 0.761 |
Diastolic pressure, mmHg | 56.51±13.34 | 56.30±15.59 | 0.899 |
Oxygen saturation, % | 95 (93-97) | 96 (93-98) | 0.263 |
Highest blood sugar, mmol/L | 8.88 (6.77-14.06) | 8.33 (6.70-12.50) | 0.306 |
Laboratory results | |||
White blood cell, 109/L | 11.56 (7.06-16.26) | 10.61 (6.20-14.89) | 0.264 |
Lymphocyte, 109/L | 0.66 (0.37-1.07) | 0.56 (0.33-1.06) | 0.275 |
Neutrophile granulocyte, 109/L | 10.57±6.75 | 9.39±6.05 | 0.098 |
Direct bilirubin, µmol/L | 9.10 (5.10-21.08) | 10.50 (5.70-32.7) | 0.148 |
AST, U/L | 41.50 (22.00-93.75) | 49.00 (25.00-109.00) | 0.163 |
Albumin, g/L | 32.97±7.10 | 33.80±7.36 | 0.233 |
Globulin, g/L | 32.34±7.52 | 32.19±8.44 | 0.861 |
Urea nitrogen, mmol/L | 6.79 (4.71-10.84) | 6.40 (4.60-10.30) | 0.503 |
Creatinine, µmol/L | 90.5 (67.0-131.0) | 88 (67-125) | 0.700 |
Cystatin-C, mg/L | 1.16 (0.90-1.69) | 1.07 (0.89-1.60) | 0.311 |
Creatine kinase, U/L | 70.50 (40.00-197.75) | 76.00 (45.00-279.00) | 0.382 |
Lactic dehydrogenase, U/L | 243.00 (194.00-329.75) | 250.00 (191.00-343.00) | 0.689 |
β-HBA, mmol/L | 0.25 (0.12-0.63) | 0.23 (0.13-0.47) | 0.450 |
INR | 1.18 (1.07-1.32) | 1.24 (1.08-1.43) | 0.028 |
D-dimer, mg/L | 4.61 (2.23-9.40) | 7.26 (1.89-9.86) | 0.394 |
PCT, µg/L | 12.44 (1.81-48.05) | 11.14 (1.30-31.69) | 0.345 |
Infection source, n (%) | |||
Lower respiratory tract | 101 (22.95) | 26 (24.30) | 0.768 |
Abdominal and gastrointestinal tract | 161 (36.59) | 47 (43.93) | 0.161 |
Other | 178 (45.45) | 34 (31.78) | 0.099 |
In-hospital mortality, n (%) | 54 (12.27) | 18 (16.82) | 0.212 |
Table 2.
Variables weighting for Emergency Bloodstream Infection Score
Variables | OR (95% CI ) | P-value | Regression coefficient | Score |
---|---|---|---|---|
Onset time, d | 0.037 | |||
≤1 | 1.000 | 0 | ||
(1,5] | 2.675 (1.026-6.977) | 0.044 | 0.984 | 3 |
(5,10] | 1.434 (0.477-4.309) | 0.521 | 0.360 | 1 |
>10 | 3.909 (1.406-10.869) | 0.009 | 1.363 | 4 |
Respiratory rate, breaths/min | <0.001 | |||
(0,23] | 1.000 | 0 | ||
(23,25] | 1.646 (0.424-6.399) | 0.472 | 0.498 | 1 |
(25,30] | 3.373 (1.178-9.655) | 0.024 | 1.216 | 3 |
>30 | 8.383 (3.066-22.924) | <0.001 | 2.126 | 6 |
Altered mental status | 5.866 (2.842-12.108) | <0.001 | 1.769 | 5 |
Lower respiratory tract infection | 4.035 (1.972-8.259) | <0.001 | 1.395 | 4 |
Table 3.
Comparison of EBS and other models in predicting the in-hospital mortality of patients with CABSIs
Models | AUC | 95% CI | P-value | P-value vs. EBS |
---|---|---|---|---|
EBS | 0.853 | 0.769-0.937 | <0.001 | |
EBS+CCI | 0.869 | 0.786-0.951 | <0.001 | 0.601 |
EBS+MJCC | 0.871 | 0.796-0.947 | <0.001 | 0.066 |
SOFA | 0.848 | 0.759-0.937 | <0.001 | 0.841 |
qSOFA | 0.779 | 0.670-0.888 | <0.001 | 0.099 |
PBS | 0.782 | 0.688-0.876 | <0.001 | 0.225 |
MEDS | 0.790 | 0.689-0.892 | <0.001 | 0.605 |
CCI | 0.667 | 0.528-0.806 | 0.026 | 0.019 |
MJCC | 0.687 | 0.538-0.835 | 0.013 | 0.059 |
Figure 1.
Decision curve analysis for predicting in-hospital mortality in CABSIs for the EBS, SOFA, MEDS, qSOFA, and PBS scores in the validation group. EBS: Emergency Community-Acquired Bloodstream Infection; MEDS: Mortality in Emergency Department Sepsis; PBS: Pitt Bacteremia Score; SOFA: Sequential Organ Failure Assessment; qSOFA: quick Sequential Organ Failure Assessment.
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