Bae Seongman, Kook Min Soo, Chang Euijin, Jung Jiwon, Kim Min Jae, Chong Yong Pil, Kim Sung-Han, Choi Sang-Ho, Lee Sang-Oh, Kim Yang Soo
Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Open Forum Infect Dis. 2024 Dec 24;12(1):ofae734. doi: 10.1093/ofid/ofae734. eCollection 2025 Jan.
Identifying risk factors for mortality in patients with bacteremia (SAB) is crucial due to its high fatality. However, data on risk factors for infection-attributable deaths considering competing risk events such as non-infection-attributable deaths remain limited. We performed a competing risk analysis to elucidate risk factors associated with 30-day infection-attributable mortality in a large cohort of patients with SAB.
This retrospective cohort study included adult patients diagnosed with SAB at a tertiary hospital from August 2008 to December 2019. Competing risk analysis was performed using Fine and Gray models to estimate subdistribution hazard ratios (sHRs) for 30-day infection-attributable death.
Among 1936 patients, 444 (22.9%) died within 30 days. Of these, 338 (76.1%) were infection-attributable and 106 (23.9%) were non-infection-attributable deaths. The multivariable Fine and Gray model identified significant risk factors for 30-day infection-attributable death (sHRs with 95% confidence intervals): an increase in age by 10 years (1.14 [1.02-1.26]), presence of malignancy (1.54 [1.17-2.02]), liver cirrhosis (2.15 [1.56-2.97]), corticosteroid use (1.61 [1.19-2.17]), septic shock (3.28 [1.98-5.42]), elevated C-reactive protein (1.60 [1.19-2.14]), pneumonia (1.81 [1.21-2.72]), persistent bacteremia (1.73 [1.31-2.30]), and failure to remove the eradicable focus (2.40 [1.38-4.19]) or absence of an eradicable focus (1.49 [1.08-2.04]). Except for age and malignancy, these factors were not significantly associated with non-infection-related death.
Specific risk factors for infection-attributable death in patients with SAB were identified, distinct from those for nonattributable death. These findings can aid in the early identification of patients at risk for SAB-attributable mortality.
由于菌血症（SAB）患者死亡率高，识别其死亡风险因素至关重要。然而，考虑到诸如非感染归因死亡等竞争风险事件，关于感染归因死亡风险因素的数据仍然有限。我们进行了一项竞争风险分析，以阐明一大群SAB患者中与30天感染归因死亡率相关的风险因素。
这项回顾性队列研究纳入了2008年8月至2019年12月在一家三级医院被诊断为SAB的成年患者。使用Fine和Gray模型进行竞争风险分析，以估计30天感染归因死亡的亚分布风险比（sHRs）。
在1936例患者中，444例（22.9%）在30天内死亡。其中，338例（76.1%）为感染归因死亡，106例（23.9%）为非感染归因死亡。多变量Fine和Gray模型确定了30天感染归因死亡的显著风险因素（sHRs及95%置信区间）：年龄每增加10岁（1.14 [1.02 - 1.26]）、存在恶性肿瘤（1.54 [1.17 - 2.02]）；肝硬化（2.15 [1.56 - 2.97]）、使用皮质类固醇（1.61 [1.19 - 2.17]）、感染性休克（3.28 [1.98 - 5.42]）、C反应蛋白升高（1.60 [1.19 - 2.14]）、肺炎（1.81 [1.21 - 2.72]）、持续性菌血症（1.73 [1.31 - 2.30]）以及未能清除可根除病灶（2.40 [1.38 - 4.19]）或不存在可根除病灶（1.49 [1.08 - 2.04]）。除年龄和恶性肿瘤外，这些因素与非感染相关死亡无显著关联。
确定了SAB患者感染归因死亡的特定风险因素，与非归因死亡的风险因素不同。这些发现有助于早期识别有SAB归因死亡风险的患者。
