Cuervo Alba, Correa Julieta, Garcés Danlela, Ascuntar Johana, León Alba, Jaimes Fabián A
Rev Chilena Infectol. 2016 Apr;33(2):150-8. doi: 10.4067/S0716-10182016000200004.
Positive blood cultures usually indicate disseminated infection that is associated with a poor prognosis and higher mortality. We seek to develop and validate a predictive model to identify factors associated with positive blood cultures in emergency patients.
Secondary analysis of data from two prospective cohorts (EPISEPSIS: developing cohort, and DISEPSIS: validation cohort) of patients with suspected or confirmed infection, assembled in emergency services in 10 hospitals in four cities in Colombia between September 2007 and February 2008. A logistic multivariable model was fitted to identify clinical and laboratory variables predictive of positive blood culture.
We analyzed 719 patients in developing and 467 in validation cohort with 32% and 21% positive blood cultures, respectively. The final predictive model included variables with significant coefficients for both cohorts: temperature > 38° C, Glasgow < 15 and platelet < 150.000 cells/mm³, with calibration (goodness-of-fit H-L) p = 0.0907 and p = 0.7003 and discrimination AUC = 0.68 (95% CI = 0.65-0.72) and 0.65 (95% CI = 0.61-0.70) in EPISEPSIS and DISEPSIS, respectively. Specifically, temperature > 38 °C and platelets < 150.000 cells/mm³ and normal Glasgow; or Glasgow < 15 with normal temperature and platelets exhibit a LR between 1,9 (CI 95% = 1,2-3,1) and 2,3 (CI 95% = 1,7-3,1). Glasgow < 15 with any of low platelets or high temperature shows a LR between 2,2 (CI 95% = 1,1-4,4) and 2,6 (CI 95% = 1,7-4,3).
Temperature > 38° C, platelet count < 150,000 cells/mm³ and GCS < 15 are variables associated with increased likelihood of having a positive blood culture.
血培养阳性通常表明存在播散性感染，这与预后不良和较高的死亡率相关。我们试图开发并验证一种预测模型，以识别急诊患者血培养阳性的相关因素。
对来自两个前瞻性队列（EPISEPSIS：开发队列，DISEPSIS：验证队列）的数据进行二次分析，这些队列是2007年9月至2008年2月期间在哥伦比亚四个城市的10家医院急诊科收集的疑似或确诊感染患者。采用多变量逻辑模型来识别预测血培养阳性的临床和实验室变量。
我们分析了开发队列中的719例患者和验证队列中的467例患者，血培养阳性率分别为32%和21%。最终的预测模型包括两个队列中具有显著系数的变量：体温>38°C、格拉斯哥昏迷评分<15分和血小板计数<150,000个/立方毫米，在EPISEPSIS和DISEPSIS队列中，校准（拟合优度H-L）p值分别为0.0907和0.7003，鉴别AUC分别为0.68（95%CI = 0.65 - 0.72）和0.65（95%CI = 0.61 - 0.70）。具体而言，体温>38°C且血小板计数<150,000个/立方毫米且格拉斯哥昏迷评分正常；或格拉斯哥昏迷评分<15分且体温和血小板计数正常，其似然比在1.9（95%CI = 1.2 - 3.1）至2.3（95%CI = 1.7 - 3.1）之间。格拉斯哥昏迷评分<15分且伴有血小板计数低或体温高，其似然比在2.2（95%CI = 1.1 - 4.4）至2.6（95%CI = 1.7 - 4.3）之间。
体温>38°C、血小板计数<150,000个/立方毫米和格拉斯哥昏迷评分<15分是与血培养阳性可能性增加相关的变量。
