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Modified Pitt bacteremia score for predicting mortality in patients with candidaemia: A multicentre seven-year
Nana Nakada-Motokawa1, Taiga Miyazaki1,2, Takashi Ueda3
1Department of Respiratory Medicine, Nagasaki University, Nagasaki, Japan.
Background:
Several severity indexes have been reported for critically ill patients. The Pitt bacteremia score (PBS) is commonly used to predict the risk of mortality in patients with bacteraemia.
Objectives:
To develop a scoring system for predicting mortality in candidaemia patients.
Methods:
Medical records at five Japanese tertiary hospitals were reviewed. Factors associated with mortality were analysed using logistic regression modelling. The discriminatory power of scoring models was evaluated by assessing the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
Results:
In total, 422 candidaemia patients were included. Higher PBS, dialysis and retainment of central venous catheter were independent risk factors for all-cause 30-day mortality. However, among the five PBS components, fever was not associated with mortality; therefore, we developed a modified version of the PBS (mPBS) by replacing fever with dialysis. AUC for PBS and mPBS were 0.74 (95% confidence interval [CI]: 0.68-0.80) and 0.76 (95% CI: 0.71-0.82), respectively. The increase in predictive ability of mPBS for 30-day mortality was statistically significant as assessed by NRI (0.24, 95% CI: 0.01-0.46, p = .04) and IRI (0.04, 95% CI: 0.02-0.06, p = .0008). When patients were stratified by mPBS into low (scores 0-3), moderate (4-7) and high risk (≥8), there were significant differences among the survival curves (p < .0001, log-rank test), and 30-day mortality rates were 13.8% (40/290), 36.8% (28/76) and 69.4% (34/49), respectively.
Conclusions:
mPBS can be a useful tool for predicting mortality in candidaemia patients.
Insights
A modified Pitt bacteremia score (mPBS) effectively predicts 30-day mortality in candidaemia patients. This new scoring system, replacing fever with dialysis, improves upon the original Pitt bacteremia score for fungal infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Medical Informatics
Background:
- Existing severity indexes like the Pitt bacteremia score (PBS) are used for critically ill patients, with PBS commonly predicting mortality in bacteremia.
- Candidaemia, a serious fungal infection, requires accurate mortality prediction tools for effective patient management.
Purpose of the Study:
- To develop and validate a novel scoring system specifically for predicting mortality in patients diagnosed with candidaemia.
- To assess the predictive performance of the new scoring system compared to existing methods.
Main Methods:
- Retrospective analysis of medical records from 422 candidaemia patients across five Japanese tertiary hospitals.
- Logistic regression modeling was employed to identify independent risk factors for 30-day all-cause mortality.
- The discriminatory power of the original Pitt bacteremia score (PBS) and a modified version (mPBS) was evaluated using AUC, NRI, and IDI.
Main Results:
- Higher PBS, dialysis, and central venous catheter retention were identified as independent risk factors for 30-day mortality in candidaemia.
- Fever, a component of PBS, was not associated with mortality; thus, a modified PBS (mPBS) replaced fever with dialysis.
- The mPBS demonstrated a statistically significant improvement in predictive ability (NRI and IDI) over the PBS, with AUCs of 0.76 for mPBS versus 0.74 for PBS.
Conclusions:
- The modified Pitt bacteremia score (mPBS) is a valuable and improved tool for predicting 30-day mortality in candidaemia patients.
- Stratification by mPBS into low, moderate, and high-risk groups revealed significant differences in survival curves and mortality rates.
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