Keller Sara C, Wang Nae-Yuh, Salinas Alejandra, Williams Deborah, Townsend Jennifer, Cosgrove Sara E
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Institute for Clinical & Translational Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Open Forum Infect Dis. 2020 May 20;7(6):ofaa178. doi: 10.1093/ofid/ofaa178. eCollection 2020 Jun.
Patients increasingly receive home-based outpatient parenteral antimicrobial therapy (OPAT). Understanding which patients might be at higher risk of complications is critical in effectively triaging resources upon and after hospital discharge.
A prospective cohort of patients discharged from 1 of 2 academic medical centers in Baltimore, Maryland, between March 2015 and December 2018 were consented and randomly divided into derivation and validation cohorts for development of a risk score for adverse OPAT outcomes. Data from the derivation cohort with the primary outcome of a serious adverse outcome (infection relapse, serious adverse drug event, serious catheter complication, readmission, or death) were analyzed to derive the risk score equation using logistic regression, which was then validated in the validation cohort for performance of predicting a serious adverse outcome.
Of 664 patients in the total cohort, half (332) experienced a serious adverse outcome. The model predicting having a serious adverse outcome included type of catheter, time on OPAT, using a catheter for chemotherapy, using a catheter for home parenteral nutrition, being treated for septic arthritis, being on vancomycin, being treated for , being treated for a fungal infection, and being treated empirically. A score ≥2 on the serious adverse outcome score had a 94.0% and 90.9% sensitivity for having a serious adverse outcome in the derivation and validation cohorts, respectively.
A risk score can be implemented to detect who may be at high risk of serious adverse outcomes, but all patients on OPAT may require monitoring to prevent or detect adverse events.
患者越来越多地接受家庭门诊胃肠外抗菌治疗（OPAT）。了解哪些患者可能发生并发症的风险较高，对于在出院时及出院后有效地分配资源至关重要。
对2015年3月至2018年12月期间从马里兰州巴尔的摩市2家学术医疗中心之一出院的患者进行前瞻性队列研究，征得患者同意后将其随机分为推导队列和验证队列，以制定OPAT不良结局的风险评分。对推导队列中以严重不良结局（感染复发、严重药物不良事件、严重导管并发症、再入院或死亡）为主要结局的数据进行分析，使用逻辑回归得出风险评分方程，然后在验证队列中对预测严重不良结局的性能进行验证。
在整个队列的664例患者中，一半（332例）经历了严重不良结局。预测发生严重不良结局的模型包括导管类型、OPAT治疗时间、使用导管进行化疗、使用导管进行家庭胃肠外营养、治疗化脓性关节炎、使用万古霉素、治疗……、治疗真菌感染以及经验性治疗。严重不良结局评分≥2分在推导队列和验证队列中发生严重不良结局的敏感性分别为94.0%和90.9%。
可以实施风险评分来检测哪些患者可能发生严重不良结局的高风险，但所有接受OPAT治疗的患者可能都需要监测，以预防或发现不良事件。
