A bacteraemia risk prediction model: development and validation in an emergency medicine population
Por:
Julian-Jimenez, A, del Castillo, JG, Garcia-Lamberechts, EJ, Sanz, IH, Bustos, CN, Diaz, RR, Tey, JMG, Llopis-Roca, F, Salmeron, PP, de Zarate, MD, Alvarez-Manzanares, J, Gamazo-Del Rio, JJ, Alonso, MA, Ordonez, BM, Lopez, OA, Romero, MDO, Reviriego, MDS, Pardo, RP, del Real, HVG, Gonzalez, MJM, Amez, JMF, Martinez, FG, Martin-Sanchez, FJ, Martin, PB, Gonzalez, FJC, Diaz-Honrubia, AJ
Publicada:
1 feb 2022
Ahead of Print:
1 sep 2021
Resumen:
Objective Design a risk model to predict bacteraemia in patients attended in emergency departments (ED) for an episode of infection. Methods This was a national, prospective, multicentre, observational cohort study of blood cultures (BC) collected from adult patients (>= 18 years) attended in 71 Spanish EDs from October 1 2019 to March 31, 2020. Variables with a p value < 0.05 were introduced in the univariate analysis together with those of clinical significance. The final selection of variables for the scoring scale was made by logistic regression with selection by introduction. The results obtained were internally validated by dividing the sample in a derivation and a validation cohort. Results A total of 4,439 infectious episodes were included. Of these, 899 (20.25%) were considered as true bacteraemia. A predictive model for bacteraemia was defined with seven variables according to the Bacteraemia Prediction Model of the INFURG-SEMES group (MPB-INFURG-SEMES). The model achieved an area under the curve-receiver operating curve of 0.924 (CI 95%:0.914-0.934) in the derivation cohort, and 0.926 (CI 95%: 0.910-0.942) in the validation cohort. Patients were then split into ten risk categories, and had the following rates of risk: 0.2%(0 points), 0.4%(1 point), 0.9%(2 points), 1.8%(3 points), 4.7%(4 points), 19.1% (5 points), 39.1% (6 points), 56.8% (7 points), 71.1% (8 points), 82.7% (9 points) and 90.1% (10 points). Findings were similar in the validation cohort. The cut-off point of five points provided the best precision with a sensitivity of 95.94%, specificity of 76.28%, positive predictive value of 53.63% and negative predictive value of 98.50%. Conclusion The MPB-INFURG-SEMES model may be useful for the stratification of risk of bacteraemia in adult patients with infection in EDs, together with clinical judgement and other variables independent of the process and the patient.
Filiaciones:
Julian-Jimenez, A:
Univ Castilla La Mancha, Complejo Hosp Univ Toledo, Emergency Dept, Toledo, Spain
del Castillo, JG:
Hosp Univ Clin San Carlos, Emergency Dept, Calle Profesor Martin Lagos Calle Profesor Martin, Madrid 28040, Spain
Hosp Univ San Carlos, Hlth Res Inst IdISSC, Madrid, Spain
Garcia-Lamberechts, EJ:
Hosp Univ Clin San Carlos, Emergency Dept, Calle Profesor Martin Lagos Calle Profesor Martin, Madrid 28040, Spain
Hosp Univ San Carlos, Hlth Res Inst IdISSC, Madrid, Spain
Sanz, IH:
Hosp Univ Donostia, Emergency Dept, San Sebastian, Spain
Bustos, CN:
Hosp Univ Virgen Macarena, Emergency Dept, Seville, Spain
Diaz, RR:
Univ Castilla La Mancha, Complejo Hosp Univ Toledo, Emergency Dept, Toledo, Spain
Tey, JMG:
Hosp Univ Sant Pau, Emergency Dept, Barcelona, Spain
Llopis-Roca, F:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Spain
Salmeron, PP:
Hosp Univ Reina Sofia, Emergency Dept, Murcia, Spain
de Zarate, MD:
Hosp Univ Basurto, Emergency Dept, Bilbao, Spain
Alvarez-Manzanares, J:
Hosp Univ Rio Hortega, Emergency Dept, Valladolid, Spain
Gamazo-Del Rio, JJ:
Hosp Univ Galdakao Usansolo, Emergency Dept, Bizkaia, Spain
Alonso, MA:
Hosp Univ Fuenlabrada, Emergency Dept, Fuenlabrada, Spain
Ordonez, BM:
Hosp Virgen Victoria, Emergency Dept, Malaga, Spain
Lopez, OA:
Hosp Univ Mostoles, Emergency Dept, Madrid, Spain
Romero, MDO:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain
Reviriego, MDS:
Hosp Nuestra Senora Prado, Emergency Dept, Talavera De La Reina, Spain
Pardo, RP:
Complejo Hosp Univ Albacete, Emergency Dept, Albacete, Spain
del Real, HVG:
Hosp Juan Ramon Jimenez Huelva, Emergency Dept, Huelva, Spain
Amez, JMF:
Hosp Clin Univ Lozano Blesa Zaragoza, Emergency Dept, Zaragoza, Spain
Martinez, FG:
Hosp Virgen Luz Cuenca, Emergency Dept, Cuenca, Spain
Martin-Sanchez, FJ:
Hosp Univ Clin San Carlos, Emergency Dept, Calle Profesor Martin Lagos Calle Profesor Martin, Madrid 28040, Spain
Hosp Univ San Carlos, Hlth Res Inst IdISSC, Madrid, Spain
Martin, PB:
Complejo Hosp Univ Toledo, Res Unit, Toledo, Spain
Gonzalez, FJC:
Hosp Univ Clin San Carlos, Dept Clin Microbiol, Madrid, Spain
Diaz-Honrubia, AJ:
Univ Politecn Madrid, ETS Comp Engn, Biomed Technol Ctr, Madrid, Spain
Complejo Hosp Univ Santiago Compostela, Emergency Dept, Santiago De Compostela, Spain.
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