Chang Jia-Mei, Lin Kuo-Hsuan, Lai Chung-Hsu, Tsai I-Ting, Hsu Yin-Chou
Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan.
School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Can J Infect Dis Med Microbiol. 2025 Jul 15;2025:6780766. doi: 10.1155/cjid/6780766. eCollection 2025.
infection causes various diseases and leads to significant morbidity and mortality. The Pitt bacteremia score (PBS) is a well-known prognostic predictor in patients with bacteremia. We aimed to investigate the prognostic role of the PBS in patients with nonbacteremic infections and compare its mortality discriminative ability with that of other risk scoring systems. Data were retrospectively collected from emergency department patients in E-Da Hospital, Kaohsiung, Taiwan, within 2021. All adult patients (aged ≥ 20 years) during this period and diagnosed with infections were included. The baseline demographics, laboratory results, infection sources, and clinical outcomes of nonbacteremic patients were extracted, and the patients were further divided into low (< 4) and high (≥ 4) PBS groups for comparison. A total of 863 patients with infection were identified, and 639 nonbacteremic patients were enrolled. There were similar demographics between the bacteremic and nonbacteremic groups. Regarding clinical outcomes in nonbacteremic patients, the high PBS group had significantly higher risk of septic shock (77.9% vs. 4.8%, < 0.01), intensive care unit admission (71.3% vs. 8.2%, < 0.01), respiratory failure (71.3% vs. 2.4%, < 0.01), and 30-day mortality (34.6% vs. 3.8%, < 0.01). The area under the curve of the scoring systems regarding 30-day mortality prediction ability was as follows: sequential organ failure assessment score 0.89 (95% confidence interval [CI] = 0.86-0.91), PBS 0.86 (95% CI = 0.83-0.88), quick sequential organ failure assessment score 0.71 (95% CI = 0.67-0.74), and systemic inflammatory response syndrome 0.62 (95% CI = 0.58-0.66). PBS correlated with adverse outcomes and good mortality prediction ability in patients with nonbacteremic infections.
感染会引发各种疾病,并导致显著的发病率和死亡率。皮特菌血症评分(PBS)是菌血症患者中一种广为人知的预后预测指标。我们旨在研究PBS在非菌血症感染患者中的预后作用,并将其死亡判别能力与其他风险评分系统进行比较。数据是从2021年台湾高雄义大医院急诊科患者中回顾性收集的。纳入了该时期内所有年龄≥20岁且被诊断为感染的成年患者。提取了非菌血症患者的基线人口统计学资料、实验室检查结果、感染源和临床结局,并将患者进一步分为低(<4)和高(≥4)PBS组进行比较。共识别出863例感染患者,其中639例非菌血症患者被纳入研究。菌血症组和非菌血症组的人口统计学资料相似。关于非菌血症患者的临床结局,高PBS组发生感染性休克的风险显著更高(77.9%对4.8%,P<0.01)、入住重症监护病房的风险显著更高(71.3%对8.2%,P<0.01)、呼吸衰竭的风险显著更高(71.3%对2.4%,P<0.01)以及30天死亡率显著更高(34.6%对3.8%,P<0.01)。各评分系统关于30天死亡率预测能力的曲线下面积如下:序贯器官衰竭评估评分0.89(95%置信区间[CI]=0.86 - 0.91),PBS 0.86(95%CI=0.83 - 0.88),快速序贯器官衰竭评估评分0.71(95%CI=0.67 - 0.74),以及全身炎症反应综合征0.62(95%CI=0.58 - 0.66)。PBS与非菌血症感染患者的不良结局相关且具有良好的死亡预测能力。