Hsieh Chia-Ming, Hu Sung-Yuan, Hsieh Ming-Shun, Huang Shih-Che, Shen Chia-Hui, Tsai Yi-Chun
Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan.
J Pers Med. 2024 Apr 3;14(4):385. doi: 10.3390/jpm14040385.
is a genus of Gram-negative bacteria found in various aquatic environments, including saltwater and freshwater. bacteremia can lead to sepsis, a potentially life-threatening condition in which the immune system enters overdrive in response to the disease, causing widespread inflammation and damage to tissues and organs. had the highest case fatality rate (39%) of all reported foodborne infections in the United States and a high mortality rate in Asia, including Taiwan. Numerous scoring systems have been created to estimate the mortality risk in the emergency department (ED). However, there are no specific scoring systems to predict the mortality risk of bacteremia. Therefore, this study modified the existing scoring systems to better predict the mortality risk of bacteremia.
Cases of bacteremia were diagnosed based on the results from at least one blood culture in the ED. Patient data were extracted from the electronic clinical database, covering January 2012 to December 2021. The primary outcome was in-hospital mortality.This study used univariate and multivariate analyses to evaluate the mortality risk.
This study enrolled 36 patients diagnosed with bacteremia, including 23 males (63.9%) and 13 females (36.1%), with a mean age of 65.1 ± 15.7 years. The in-hospital mortality rate amounted to 25% (9/36), with 31.5% in (6/19) and 17.6% in non- (3/17). The non-survivors demonstrated higher MEDS (10.3 ± 2.4) than the survivors (6.2 ± 4.1) ( = 0.002). Concerning the qSOFA, the survivors scored 0.3 ± 0.5, and the non-survivors displayed a score of 0.6 ± 0.7 ( = 0.387). The AUC of the ROC for the MEDS and qSOFA was 0.833 and 0.599, respectively. This study modified the scoring systems with other predictive factors, including BUN and pH. The AUC of the ROC for the modified MEDS and qSOFA reached up to 0.852 and 0.802, respectively.
The MEDS could serve as reliable indicators for forecasting the mortality rate of patients grappling with bacteremia. This study modified the MEDS and qSOFA to strengthen the predictive performance of mortality risk for bacteremia. We advocate the prompt initiation of targeted therapeutic interventions and judicious antibiotic treatments to curb fatality rates.
[细菌名称]是一种革兰氏阴性菌属，存在于各种水生环境中，包括咸水和淡水。[细菌名称]菌血症可导致脓毒症，这是一种潜在的危及生命的病症，免疫系统会因应对该疾病而进入过度活跃状态，引发广泛炎症以及对组织和器官的损害。在美国所有报告的食源性感染中，[细菌名称]菌血症的病死率最高（39%），在亚洲，包括台湾地区，其死亡率也很高。已经创建了许多评分系统来估计急诊科（ED）患者的死亡风险。然而，目前尚无专门用于预测[细菌名称]菌血症死亡风险的评分系统。因此，本研究对现有的评分系统进行了修改，以更好地预测[细菌名称]菌血症的死亡风险。
根据急诊科至少一次血培养的结果诊断[细菌名称]菌血症病例。从电子临床数据库中提取2012年1月至2021年12月期间的患者数据。主要结局是住院死亡率。本研究采用单因素和多因素分析来评估死亡风险。
本研究纳入了36例诊断为[细菌名称]菌血症的患者，其中男性23例（63.9%），女性13例（36.1%），平均年龄为65.1±15.7岁。住院死亡率为25%（9/36），[细菌名称]菌血症患者中的死亡率为31.5%（6/19），非[细菌名称]菌血症患者中的死亡率为17.6%（3/17）。非幸存者的改良急诊医学严重程度评分（MEDS）（10.3±2.4）高于幸存者（6.2±4.1）（P = 0.002）。关于快速序贯器官衰竭评估（qSOFA），幸存者的评分为0.3±0.5，非幸存者的评分为0.6±0.7（P = 0.387）。MEDS和qSOFA的受试者工作特征曲线（ROC）下面积（AUC）分别为0.833和0.599。本研究将其他预测因素，包括血尿素氮（BUN）和pH值纳入评分系统进行修改。修改后的MEDS和qSOFA的ROC曲线下面积分别高达0.852和0.802。
MEDS可作为预测[细菌名称]菌血症患者死亡率的可靠指标。本研究对MEDS和qSOFA进行了修改，以增强对[细菌名称]菌血症死亡风险的预测性能。我们提倡及时启动针对性的治疗干预措施和合理使用抗生素治疗，以降低死亡率。
