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Updated: Jun 12, 2025
Posterior Approach for Debridement of the Psoas Abscess
Published on: March 2, 2020
A simple scoring algorithm predicting paravertebral and/or iliopsoas abscess among adults with community-onset
Ching-Chi Lee1,2, Ching-Yu Ho3,4, Ming-Yuan Hong2,5
1Clinical Medical Research Center, Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 70403, Taiwan.
Purpose:
Misdiagnosis or delayed diagnosis of paravertebral and/or iliopsoas abscess (PVIPA) has been frequently reported to be associated with unfavorable prognosis. We aimed to develop a scoring algorithm that can easily and accurately identify patients at greater risk for PVIPA among individuals with community-onset bloodstream infections.
Methods:
In a multicenter, retrospective cohort study, the score was developed with the first four study years and validated with the remaining two years. Applying logistic regression, the score values of prediction determinants were derived from the adjusted odds ratios (AOR). The performance of the scoring algorithm was assessed with the receiver operating characteristic (ROC) curve.
Results:
In the derivation (3869 patients) and validation (1608) cohorts, patients with PVIPA accounted for 1.7% and 1.4%, respectively. In the derivation cohort, five independent predictors of PVIPA were recognized using multivariable analyses: time-to-defervescence > 5 days (AOR, 7.00; 2 points), Panton-Valentine Leukocidin (PVL)-producing Staphylococcus aureus (AOR, 5.98; 2 points), intravenous drug users (AOR, 2.60; 1 points), and comorbid hemato-oncology (AOR, 0.41; -1 point) or liver cirrhosis (AOR, 2.56; 1 points). In the derivation and validation cohorts, areas under ROC curves (95% confidence intervals) of the prediction algorithm are 0.83 (0.77-0.88) and 0.85 (0.80-0.90), and a cutoff score of + 2 represents sensitivity of 83.3% and 95.7%, specificity of 68.6% and 67.7%, positive predictive values of 4.4% and 4.1%, and negative predictive values of 99.6% and 99.9%, respectively.
Conclusions:
Of a scoring algorithm with substantial sensitivity and specificity in predicting PVIPA, PVL-producing S. aureus and Time-to-defervescence > 5 days were crucial determinants.
Insights
A new scoring algorithm accurately identifies patients with community-onset bloodstream infections at higher risk for paravertebral and/or iliopsoas abscess (PVIPA). Key predictors include Panton-Valentine Leukocidin (PVL)-producing Staphylococcus aureus and delayed fever resolution, improving early diagnosis.
Area of Science:
- Infectious Diseases
- Medical Diagnostics
- Public Health
Background:
- Paravertebral and/or iliopsoas abscess (PVIPA) diagnosis is often delayed, leading to poor patient outcomes.
- Early identification of PVIPA in patients with community-onset bloodstream infections is crucial for timely intervention.
Purpose of the Study:
- To develop and validate a predictive scoring algorithm for PVIPA in patients with community-onset bloodstream infections.
- To identify key clinical and microbiological predictors of PVIPA.
Main Methods:
- A multicenter, retrospective cohort study involving derivation (4 years) and validation (2 years) cohorts.
- Logistic regression analysis was used to derive prediction determinants and their associated odds ratios.
- Receiver operating characteristic (ROC) curves were employed to assess the algorithm's performance.
Main Results:
- The study identified five independent predictors of PVIPA: time-to-defervescence >5 days, Panton-Valentine Leukocidin (PVL)-producing Staphylococcus aureus, intravenous drug use, and comorbid hemato-oncology or liver cirrhosis.
- The scoring algorithm demonstrated substantial predictive performance, with areas under the ROC curve of 0.83 in the derivation cohort and 0.85 in the validation cohort.
- A cutoff score of +2 yielded high sensitivity (83.3%-95.7%) and negative predictive values (99.6%-99.9%) for PVIPA detection.
Conclusions:
- A novel scoring algorithm effectively predicts PVIPA in patients with community-onset bloodstream infections.
- Panton-Valentine Leukocidin (PVL)-producing S. aureus and delayed defervescence (>5 days) are critical determinants for PVIPA risk.
- The developed algorithm offers a valuable tool for early risk stratification and improved management of PVIPA.
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