Lesens Olivier, Methlin Cédric, Hansmann Yves, Remy Véronique, Martinot Martin, Bergin Colm, Meyer Pierre, Christmann Daniel
Service des Maladies Infectieuses et Tropicales, Clinique Médicale A, Hôpitaux Universitaires, Strasbourg, France.
Infect Control Hosp Epidemiol. 2003 Dec;24(12):890-6. doi: 10.1086/502156.
To demonstrate the effectiveness of the Charlson weighted index of comorbidity (WIC) for controlling comorbidity in prospective studies focusing on mortality in patients with Staphylococcus aureus bacteremia (SAB).
Cohort study.
Two tertiary-care, university-affiliated hospitals in France.
One hundred sixty-six inpatients 18 years or older consecutively diagnosed with SAB from May 15, 2001, to May 15, 2002.
Patients were prospectively assessed and cases were followed by the infectious diseases consult service at least 3 months after effective antibiotic therapy completion. The Charlson WIC was computed and dichotomized into scores of fewer than 3 points and 3 or more points. Bacteremia source, acute complication due to SAB acquisition in the ICU, and inappropriate empiric antibiotic therapy were recorded. The endpoint was death due to SAB and overall mortality.
In univariate analysis, the Charlson WIC was able to predict overall mortality and S. aureus-related death. The following variables were found to be independently predictive of mortality due to SAB using the Cox model: an acute complication due to S. aureus (OR, 8.9; CI95, 4 to 19.7; P < .001), a Charlson WIC score of 3 or more (OR, 3; CI95, 1.3 to 5.5; P = .006), and age (OR, 1.04; CI95, 1.009 to 1.07; P < .01).
Comorbidity contributes to death in patients with SAB. The Charlson WIC is a good predictor of mortality in this population and may be a useful instrument to control comorbidity in studies aiming to investigate risk factors for death due to bacteremia.
在针对金黄色葡萄球菌菌血症（SAB）患者死亡率的前瞻性研究中，证明查尔森合并症加权指数（WIC）在控制合并症方面的有效性。
队列研究。
法国两家大学附属的三级医疗医院。
2001年5月15日至2002年5月15日期间连续诊断为SAB的166例18岁及以上住院患者。
对患者进行前瞻性评估，病例在有效抗生素治疗结束后至少3个月由传染病咨询服务部门进行随访。计算查尔森WIC并将其分为低于3分和3分及以上两组。记录菌血症来源、重症监护病房（ICU）中因SAB感染导致的急性并发症以及不恰当的经验性抗生素治疗情况。终点为因SAB导致的死亡和总死亡率。
在单变量分析中，查尔森WIC能够预测总死亡率和金黄色葡萄球菌相关死亡。使用Cox模型发现以下变量可独立预测因SAB导致的死亡率：金黄色葡萄球菌引起的急性并发症（比值比[OR]，8.9；95%置信区间[CI95]，4至19.7；P <.001）、查尔森WIC评分3分及以上（OR，3；CI95，1.3至5.5；P =.006）以及年龄（OR，1.04；CI95，1.009至1.07；P <.01）。
合并症导致SAB患者死亡。查尔森WIC是该人群死亡率的良好预测指标，在旨在调查菌血症所致死亡危险因素的研究中可能是控制合并症的有用工具。
