Su Ching, Tsai I-Ting, Lai Chung-Hsu, Lin Kuo-Hsuan, Chen Chia-Chi, Hsu Yin-Chou
Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, 82445, Taiwan.
School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Infect Drug Resist. 2023 Jul 25;16:4807-4815. doi: 10.2147/IDR.S420569. eCollection 2023.
is an important causative pathogen of nosocomial infections, resulting in poor prognosis owing to its hypervirulence and antibiotic resistance. A simplified quicker version of the Pitt bacteremia score (PBS) (qPitt) for acute illness severity measurement was developed recently. The goal of this study was to explore the prognostic value of qPitt in patients with infection.
Demographic information and management strategies were retrospectively collected from the records of all adult patients who visited the emergency department between January 1, 2021, and December 31, 2021, with culture-positive . The qPitt score was calculated based on: temperature <36°C, systolic blood pressure ≤90 mmHg or vasopressor administration, respiratory rate ≥25 times/min or need of mechanical ventilation, altered mental status, and cardiac arrest event. The 30-day mortality prediction abilities of the qPitt were compared with the PBS, the sequential organ failure assessment (SOFA), and the quick sequential organ failure assessment (qSOFA) using receiver operating characteristic curves.
Data from 867 patients (57.8% men) with a mean age of 66.9 were compiled. The 30-day mortality rate of the enrolled patients was 13.4%, and the area under the curve (AUC) of the scoring systems were as follows: SOFA, 0.91 (95% confidence interval [CI]=0.89-0.93), qPitt, 0.87 (95% CI=0.84-0.89), PBS, 0.87 (95% CI=0.85-0.89), and qSOFA, 0.73 (95% CI=0.70-0.76). The AUC of qPitt was significantly higher than that of qSOFA (<0.01) and similar to that of PBS (=0.65).The qPitt also demonstrated excellent mortality discrimination ability in non-bacteremic patients, AUC= 0.85 (95% CI=0.82-0.88).
The qPitt revealed excellent 30-day mortality prediction ability and also predicted mortality in non-bacteremic patients with infection. Clinicians can use this simplified scoring system to stratify patients earlier and initiate prompt treatment in high-risk patients.
是医院感染的一种重要致病病原体，因其高毒力和抗生素耐药性导致预后不良。最近开发了一种用于测量急性疾病严重程度的简化快速版皮特菌血症评分（PBS）（qPitt）。本研究的目的是探讨qPitt在感染患者中的预后价值。
回顾性收集2021年1月1日至2021年12月31日期间就诊于急诊科且血培养阳性的所有成年患者的记录中的人口统计学信息和管理策略。qPitt评分基于以下因素计算：体温<36°C、收缩压≤90 mmHg或使用血管升压药、呼吸频率≥25次/分钟或需要机械通气、精神状态改变以及心脏骤停事件。使用受试者工作特征曲线比较qPitt与PBS、序贯器官衰竭评估（SOFA）和快速序贯器官衰竭评估（qSOFA）对30天死亡率的预测能力。
汇总了867例患者（男性占57.8%）的数据，平均年龄为66.9岁。入选患者的30天死亡率为13.4%，各评分系统的曲线下面积（AUC）如下：SOFA为0.91（95%置信区间[CI]=0.89 - 0.93），qPitt为0.87（95% CI=0.84 - 0.89），PBS为0.87（95% CI=0.85 - 0.89），qSOFA为0.73（95% CI=0.70 - 0.76）。qPitt的AUC显著高于qSOFA（<0.01），且与PBS相似（=0.65）。qPitt在非菌血症患者中也表现出出色的死亡率判别能力，AUC = 0.85（95% CI=0.82 - 0.88）。
qPitt显示出出色的30天死亡率预测能力，并且还能预测非菌血症感染患者的死亡率。临床医生可以使用这种简化的评分系统更早地对患者进行分层，并对高危患者启动及时治疗。
