Wang Chung-Pang, Hsieh Ming-Shun, Hu Sung-Yuan, Huang Shih-Che, Tsai Che-An, Shen Chia-Hui
Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan 330, Taiwan.
Diagnostics (Basel). 2024 Apr 23;14(9):869. doi: 10.3390/diagnostics14090869.
The mortality rate of afebrile bacteremia has been reported to be as high as 45%. This investigation focused on the risk factors and predictive performance of scoring systems for the clinical outcomes of afebrile patients with monomicrobial gram-negative bacteria (GNB) in the emergency department (ED).
We conducted a retrospective analysis of afebrile adult ED patients with monomicrobial GNB bacteremia from January 2012 to December 2021. We dissected the demographics, clinical pictures, and laboratory investigations. We applied five scoring systems and three revised systems to predict the clinical outcomes.
There were 600 patients included (358 males and 242 females), with a mean age of 69.6 ± 15.4 years. The overall mortality rate was 50.17%, reaching 68.52% (74/108) in cirrhotic patients. was the leading pathogen (42.83%). The non-survivors had higher scores of the original MEDS ( < 0.001), NEWS ( < 0.001), MEWS ( < 0.001), qSOFA ( < 0.001), and REMS ( = 0.030). In univariate logistic regression analyses, several risk factors had a higher odds ratio (OR) for mortality, including liver cirrhosis (OR 2.541, < 0.001), malignancy (OR 2.259, < 0.001), septic shock (OR 2.077, = 0.002), and male gender (OR 0.535, < 0.001). The MEDS demonstrated that the best predictive power with the maximum area under the curve (AUC) was measured at 0.773 at the cut-off point of 11. The AUCs of the original NEWS, MEWS, qSOFA, and REMS were 0.663, 0.584, 0.572, and 0.553, respectively. We revised the original MEDS, NEWS, and qSOFA by adding red cell distribution width, albumin, and lactate scores and found a better predictive power of the AUC of 0.797, 0.719, and 0.694 on the revised MEDS ≥11, revised qSOFA ≥ 3, and revised NEWS ≥ 6, respectively.
The original MEDS, revised MEDS, revised qSOFA, and revised NEWS were valuable tools for predicting the mortality risk in afebrile patients with monomicrobial GNB bacteremia. We suggested that clinicians should explore patients with the risk factors mentioned above for possible severe infection, even in the absence of fever and initiate hemodynamic support and early adequate antibiotic therapy in patients with higher scores of the original MEDS (≥11), revised MEDS (≥11), revised NEWS (≥6), and revised qSOFA (≥3).
据报道，无发热性菌血症的死亡率高达45%。本研究聚焦于急诊科（ED）中患有单微生物革兰氏阴性菌（GNB）的无发热患者临床结局的评分系统的危险因素及预测性能。
我们对2012年1月至2021年12月在急诊科的患有单微生物GNB菌血症的无发热成年患者进行了回顾性分析。我们剖析了人口统计学、临床表现及实验室检查结果。我们应用了五种评分系统及三种修订系统来预测临床结局。
共纳入600例患者（男性358例，女性242例），平均年龄69.6±15.4岁。总体死亡率为50.17%，肝硬化患者中死亡率达68.52%（74/108）。大肠埃希菌是主要病原体（42.83%）。非存活者的原始改良早期预警评分（MEDS）（P<0.001）、国家早期预警评分（NEWS）（P<0.001）、改良早期预警评分（MEWS）（P<0.001）、快速序贯器官衰竭评估（qSOFA）（P<0.001）及快速急诊医学评分（REMS）（P = 0.030）得分更高。在单因素逻辑回归分析中，几个危险因素的死亡比值比（OR）更高，包括肝硬化（OR 2.541，P<0.001）、恶性肿瘤（OR 2.259，P<0.001）、感染性休克（OR 2.077，P = 0.002）及男性（OR 0.535，P<0.001）。MEDS显示在截断值为11时曲线下面积（AUC）最大，预测能力最佳，为0.773。原始NEWS、MEWS、qSOFA及REMS的AUC分别为0.663、0.584、0.572及0.553。我们通过增加红细胞分布宽度、白蛋白及乳酸得分对原始MEDS、NEWS及qSOFA进行了修订，发现修订后的MEDS≥11、修订后的qSOFA≥3及修订后的NEWS≥6时，AUC分别为0.797、0.719及0.694，预测能力更佳。
原始MEDS、修订后的MEDS、修订后的qSOFA及修订后的NEWS是预测患有单微生物GNB菌血症的无发热患者死亡风险的有价值工具。我们建议临床医生应筛查有上述危险因素的患者是否可能存在严重感染，即使无发热，并对原始MEDS（≥11）、修订后的MEDS（≥11）、修订后的NEWS（≥6）及修订后的qSOFA（≥
