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[5MPB-托莱多模型在急诊科预测社区获得性肺炎患者菌血症中的应用价值]

[Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department].

作者信息

Julián-Jiménez A, González Del Castillo J, García-Lamberechts E J, Rubio Díaz R, Huarte Sanz I, Navarro Bustos C, Martín-Sánchez F J, Candel F J

机构信息

Agustín Julián-Jiménez, Servicio de Urgencias-Coordinador de Docencia, Formación, Investigación y Calidad. Complejo Hospitalario Universitario de Toledo, Toledo, Spain.

出版信息

Rev Esp Quimioter. 2021 Aug;34(4):376-382. doi: 10.37201/req/043.2021. Epub 2021 May 25.

Abstract

OBJECTIVE

To analyse a new risk score to predict bacteremia in the patients with Community-acquired Pneumonia (CAP) in the emergency departments.

METHODS

Prospective and multicenter observational cohort study of the blood cultures ordered in 74 Spanish emergency departments for patients with CAP seen from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the chosen cut-off for getting the sensitivity, specificity, positive predictive value and negative predictive value.

RESULTS

A total of 1,020 blood samples wered cultured. True cases of bacteremia were confirmed in 162 (15.9%). The remaining 858 cultures (84.1%) wered negative. And, 59 (5.8%) were judged to be contaminated. The model´s area under the receiver operating characteristic curve was 0.915 (95% CI, 0.898-0.933). The prognostic performance with a model´s cut-off value of ≥ 5 points achieved 97.5% (95% CI, 95.1-99.9) sensitivity, 73.2% (95% CI, 70.2-76.2) specificity, 40.9% (95% CI, 36.4-45.1) positive predictive value and 99.4% (95% CI, 99.1-99.8) negative predictive value.

CONCLUSIONS

The 5MPB-Toledo score is useful for predicting bacteremia in the patients with CAP seen in the emergency departments.

摘要

目的

分析一种新的风险评分,以预测急诊科社区获得性肺炎(CAP)患者的菌血症情况。

方法

对2019年11月1日至2020年3月31日期间在西班牙74个急诊科就诊的CAP患者所进行的血培养进行前瞻性多中心观察队列研究。采用受试者工作特征曲线下面积(AUC-ROC)分析该模型的预测能力。根据选定的临界值计算菌血症的真实预后性能,以获得敏感性、特异性、阳性预测值和阴性预测值。

结果

共培养了1020份血样。确诊菌血症的真实病例有162例(15.9%)。其余858份培养物(84.1%)为阴性。另外,59份(5.8%)被判定为污染。该模型的受试者工作特征曲线下面积为0.915(95%CI,0.898-0.933)。模型临界值≥5分时的预后性能达到敏感性97.5%(95%CI,95.1-99.9)、特异性73.2%(95%CI,70.2-76.2)、阳性预测值40.9%(95%CI,36.4-45.1)和阴性预测值99.4%(95%CI,99.1-99.8)。

结论

5MPB-托莱多评分有助于预测急诊科CAP患者的菌血症情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c7ca/8329573/4cfe0f5e6b7a/revespquimioter-34-376-g001.jpg

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