Oh Yeseul, Roh Jiyeon, Lee Jaemin, Chung Hyun Sung, Lee Kwangha, Lee Min Ki
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
Acute Crit Care. 2020 Aug;35(3):169-178. doi: 10.4266/acc.2020.00143. Epub 2020 Aug 31.
The occurrence of multidrug-resistant (MDR) bacteremia in ventilated patients may be associated with a high mortality rate. We evaluated whether Sequential Organ Failure Assessment (SOFA) score on the day of bacteremia could predict 90-day mortality in these patients.
Data were obtained retrospectively from 202 patients (male, 60.4%; median age, 64 years) hospitalized at a single university-affiliated tertiary care hospital. All adult patients who had were ventilated and had one of the following six MDR bacteremias between March 2011 and February 2018 were enrolled: methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Gram-negative bacteria (Escherichia coli and Klebsiella pneumonia), carbapenem-resistant Gram-negative rods (Acinetobacter baumannii and Pseudomonas aeruginosa), or vancomycin-resistant Enterococcus faecium.
The overall 90-day mortality rate after the day of bacteremia was 59.9%. The areas under the receiver operating characteristic curves for the SOFA and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 0.732 (95% confidence interval [CI], 0.666 to 0.792; P<0.001) and 0.662 (95% CI, 0.593 to 0.727; P<0.001), respectively, with no difference between the two (P=0.059). Also, the cutoff value of the SOFA score was 9 (based on Youden's index). Multivariate Cox regression analysis showed that this cut-off value was significantly associated with higher mortality rate (hazard ratio, 2.886; 95% CI, 1.946 to 4.221; P<0.001).
SOFA score measured on the day of bacteremia may be a useful prognostic indicator of 90-day mortality in ventilated patients with MDR bacteremia.
机械通气患者中多重耐药（MDR）菌血症的发生可能与高死亡率相关。我们评估了菌血症当天的序贯器官衰竭评估（SOFA）评分是否能够预测这些患者的90天死亡率。
回顾性收集了一所大学附属医院202例住院患者的数据（男性占60.4%；中位年龄64岁）。纳入了2011年3月至2018年2月期间所有进行机械通气且发生以下六种MDR菌血症之一的成年患者：耐甲氧西林金黄色葡萄球菌、产超广谱β-内酰胺酶革兰阴性菌（大肠埃希菌和肺炎克雷伯菌）、耐碳青霉烯类革兰阴性杆菌（鲍曼不动杆菌和铜绿假单胞菌）或耐万古霉素粪肠球菌。
菌血症发生后的总体90天死亡率为59.9%。SOFA评分和急性生理与慢性健康状况评估（APACHE）II评分的受试者工作特征曲线下面积分别为0.732（95%置信区间[CI]，0.666至0.792；P<0.001）和0.662（95%CI，0.593至0.727；P<0.001），两者之间无差异（P=0.059）。此外，SOFA评分的临界值为9（基于约登指数）。多因素Cox回归分析显示，该临界值与较高的死亡率显著相关（风险比，2.886；95%CI，1.946至4.221；P<0.001）。
菌血症当天测得的SOFA评分可能是MDR菌血症机械通气患者90天死亡率的一个有用的预后指标。
