Department of Respiratory Medicine, Nagasaki University, Nagasaki, Japan.
Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Mycoses. 2021 Dec;64(12):1498-1507. doi: 10.1111/myc.13380. Epub 2021 Oct 23.
Several severity indexes have been reported for critically ill patients. The Pitt bacteremia score (PBS) is commonly used to predict the risk of mortality in patients with bacteraemia.
To develop a scoring system for predicting mortality in candidaemia patients.
Medical records at five Japanese tertiary hospitals were reviewed. Factors associated with mortality were analysed using logistic regression modelling. The discriminatory power of scoring models was evaluated by assessing the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
In total, 422 candidaemia patients were included. Higher PBS, dialysis and retainment of central venous catheter were independent risk factors for all-cause 30-day mortality. However, among the five PBS components, fever was not associated with mortality; therefore, we developed a modified version of the PBS (mPBS) by replacing fever with dialysis. AUC for PBS and mPBS were 0.74 (95% confidence interval [CI]: 0.68-0.80) and 0.76 (95% CI: 0.71-0.82), respectively. The increase in predictive ability of mPBS for 30-day mortality was statistically significant as assessed by NRI (0.24, 95% CI: 0.01-0.46, p = .04) and IRI (0.04, 95% CI: 0.02-0.06, p = .0008). When patients were stratified by mPBS into low (scores 0-3), moderate (4-7) and high risk (≥8), there were significant differences among the survival curves (p < .0001, log-rank test), and 30-day mortality rates were 13.8% (40/290), 36.8% (28/76) and 69.4% (34/49), respectively.
mPBS can be a useful tool for predicting mortality in candidaemia patients.
已有多种严重程度指数用于危重症患者。皮特菌血症评分（PBS）常用于预测菌血症患者的死亡风险。
建立一种用于预测念珠菌血症患者死亡率的评分系统。
回顾日本五家三级医院的病历。使用逻辑回归模型分析与死亡率相关的因素。通过评估受试者工作特征曲线下面积（AUC）、净重新分类改善（NRI）和综合判别改善（IDI）来评估评分模型的判别能力。
共纳入 422 例念珠菌血症患者。较高的 PBS、透析和中心静脉导管留置是全因 30 天死亡率的独立危险因素。然而，在 PBS 的五个组成部分中，发热与死亡率无关；因此，我们通过用透析替代发热来修改 PBS（mPBS）。PBS 和 mPBS 的 AUC 分别为 0.74（95%置信区间[CI]：0.68-0.80）和 0.76（95%CI：0.71-0.82）。NRI（0.24，95%CI：0.01-0.46，p=0.04）和 IRI（0.04，95%CI：0.02-0.06，p=0.0008）评估表明，mPBS 对 30 天死亡率的预测能力提高具有统计学意义。当根据 mPBS 将患者分为低危（评分 0-3）、中危（4-7）和高危（≥8）时，生存曲线之间存在显著差异（p<0.0001，对数秩检验），30 天死亡率分别为 13.8%（40/290）、36.8%（28/76）和 69.4%（34/49）。
mPBS 可作为预测念珠菌血症患者死亡率的有用工具。
