Mycoses. 2021 Oct 16. doi: 10.1111/myc.13380. Online ahead of print.
ABSTRACT
BACKGROUND: Several severity indexes have been reported for critically ill patients. The Pitt bacteremia score (PBS) is commonly used to predict the risk of mortality in patients with bacteremia.
OBJECTIVES: To develop a scoring system for predicting mortality in candidemia patients.
METHODS: Medical records at five Japanese tertiary hospitals were reviewed. Factors associated with mortality were analysed using logistic regression modelling. The discriminatory power of scoring models was evaluated by assessing the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
RESULTS: In total, 422 candidemia patients were included. Higher PBS, dialysis, and retainment of central venous catheter were independent risk factors for all-cause 30-day mortality. However, among the five PBS components, fever was not associated with mortality; therefore, we developed a modified version of the PBS (mPBS) by replacing fever with dialysis. AUC for PBS and mPBS was 0.74 (95% confidence interval [CI]: 0.68-0.80) and 0.76 (95% CI: 0.71-0.82), respectively. The increase in predictive ability of mPBS for 30-day mortality was statistically significant as assessed by NRI (0.24, 95% CI: 0.01-0.46, P=0.04) and IRI (0.04, 95% CI: 0.02-0.06, P=0.0008). When patients were stratified by mPBS into low (scores 0-3), moderate (4-7), and high risk (≥8), there were significant differences among the survival curves (P<0.0001, log-rank test), and 30-day mortality rates were 13.8% (40/290), 36.8% (28/76), and 69.4% (34/49), respectively.
CONCLUSIONS: mPBS can be a useful tool for predicting mortality in candidemia patients.
PMID:34655487 | DOI:10.1111/myc.13380
