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Measuring patient-centred long-term outcome following a bloodstream infection: a pilot study
J F McNamara1, P N A Harris2, M D Chatfield3
1The University of Queensland, Centre for Clinical Research, Herston, Brisbane, Australia; The Prince Charles Hospital, Brisbane, Australia.
Objectives:
To evaluate the sequential organ failure assessment (SOFA) and modified SOFA (mSOFA) scoring and a novel performance score based on the Karnofsky score for measuring outcome following a bloodstream infection (BSI).
Method:
This prospective observational cohort study assessed patients with BSI for mortality and functional outcomes with a novel performance score: the functional bloodstream infection score (FBIS). We also tested the SOFA and, given the difficulties with measuring SOFA on ward-based patients, the mSOFA over the first 7 days following a BSI for their association with outcomes.
Results:
One hundred participants were prospectively recruited. Mortality at 52 weeks following BSI was 21% (21/100). Only 57% of survivors (39/69) were at their baseline functional status at 52 weeks. Stable or improved SOFA/mSOFA over the first 7 days was associated with survival and return to premorbid performance score (risk ratio 3.2, 95%CI 1.3-9.4, p < 0.01).
Conclusions:
The acute change in SOFA/mSOFA was associated with 52-week survival and return to premorbid functional performance. The FBIS measurement represents a simple and easy-to-apply measure of functional performance for patients with BSI and was associated with a high response rate (89%) from participants.
Insights
Stable Sequential Organ Failure Assessment (SOFA) and modified SOFA (mSOFA) scores within 7 days of bloodstream infection (BSI) predict survival and functional recovery. A new Functional Bloodstream Infection Score (FBIS) also effectively measures patient outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Prognostic Biomarkers
Background:
- Bloodstream infections (BSI) are associated with significant mortality and long-term functional impairment.
- Accurate outcome prediction is crucial for managing BSI patients.
- Existing scoring systems may have limitations in assessing functional status in ward-based patients.
Purpose of the Study:
- To evaluate the prognostic value of Sequential Organ Failure Assessment (SOFA) and modified SOFA (mSOFA) scores for outcomes following BSI.
- To assess a novel performance score, the Functional Bloodstream Infection Score (FBIS), based on the Karnofsky score, for measuring functional outcomes post-BSI.
Main Methods:
- Prospective observational cohort study of 100 patients with BSI.
- Assessment of mortality and functional outcomes using the FBIS.
- Evaluation of SOFA and mSOFA scores within the first 7 days post-BSI for association with outcomes.
Main Results:
- Mortality at 52 weeks post-BSI was 21%.
- Only 57% of survivors returned to their baseline functional status at 52 weeks.
- Stable or improved SOFA/mSOFA scores in the first 7 days were associated with survival and return to premorbid functional status (Risk Ratio 3.2).
Conclusions:
- Acute changes in SOFA/mSOFA scores are associated with 52-week survival and functional recovery after BSI.
- The FBIS is a simple, easily applicable measure of functional performance in BSI patients with a high participant response rate (89%).
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