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A nomogram for predicting in-hospital mortality in patients with coagulase-negative staphylococcus bloodstream
Junjin Liu1, Liang Gao1, Qichao Fan1
1Department of Infectious Diseases, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Infectious Diseases, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
Introduction:
Coagulase-negative staphylococci (CoNS) have emerged as significant pathogens in bloodstream infections (BSIs). Currently, no validated models exist for specifically predicting in-hospital mortality in patients with CoNS-BSIs.
Methods:
A retrospective study was conducted on adult patients with CoNS-BSIs using the Medical Information Mart for Intensive Care (MIMIC-III) database. Participants were randomly allocated into a training set (n=366) and a validation set (n=157). Demographic characteristics, severity scores, comorbidities and laboratory examinations from the first 24 hours of ICU admission were analyzed. The optimal predictive variables for establishing a nomogram were screened through univariate, multivariate logistic regression and stepwise regression analyses. Model performance was evaluated by receiver operator characteristic (ROC) curve, calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC).
Results:
Among 523 patients enrolled, the overall in-hospital mortality was 22.9%. Four independent predictors were incorporated into the nomogram: age (OR=1.04), anion gap (AG: OR=1.11), total bilirubin (TBil: OR=1.26) and respiratory failure (OR=1.97). The area under the curve (AUC) values in the training set and validation set were 0.758 and 0.823, respectively. The P-values of the calibration curve in two sets were 0.258 and 0.432. The DCA curves were above the two extreme curves. The CIC analysis revealed a high concordance between predicted high-risk cases and observed clinical events when the risk threshold exceeded 60%.
Conclusion:
Age, AG, TBil and respiratory failure were independent risk factors for in-hospital mortality among patients with CoNS-BSIs. The nomogram based on these four parameters demonstrated good performance and clinical utility for risk assessment.
