背景:据报道,无热菌血症的死亡率高达45%。这项研究的重点是急诊科(ED)中使用单抗微生物革兰氏阴性菌(GNB)的无脑患者临床结局的风险因素和评分系统的预测性能。
方法:我们对2012年1月至2021年12月患有单一抗菌GNB菌血症的无血成人ED患者进行了回顾性分析。我们解剖了人口统计,临床图片,和实验室调查。我们应用了五个评分系统和三个修订的系统来预测临床结果。
结果:纳入600例患者(男性358例,女性242例),平均年龄69.6±15.4岁。总死亡率为50.17%,在肝硬化患者中达到68.52%(74/108)。大肠埃希菌为主要病原菌(42.83%)。非幸存者的原始MEDS得分较高(p<0.001),新闻(p<0.001),MEWS(p<0.001),qSOFA(p<0.001),和REMS(p=0.030)。在单变量逻辑回归分析中,几个危险因素的死亡率比值比(OR)较高,包括肝硬化(OR2.541,p<0.001),恶性肿瘤(OR2.259,p<0.001),感染性休克(OR2.077,p=0.002),和男性(OR0.535,p<0.001)。MEDS表明,在11的截止点0.773处测量到具有最大曲线下面积(AUC)的最佳预测能力。原始新闻的AUC,MEWS,qSOFA,和REMS分别为0.663、0.584、0.572和0.553。我们修改了原始的MEDS,新闻,和qSOFA,通过增加红细胞分布宽度,白蛋白,和乳酸评分,分别在修订的MEDS≥11,修订的qSOFA≥3和修订的NEWS≥6时,AUC的预测能力分别为0.797,0.719和0.694。
结论:原始MEDS,修订后的MEDS,修订后的qSOFA,和修订后的NEWS是预测单一抗菌素GNB菌血症的发热患者死亡风险的有价值的工具.我们建议临床医生应探索具有上述危险因素的患者可能的严重感染,即使在没有发烧的情况下,对原始MEDS评分较高(≥11)的患者开始血流动力学支持和早期适当的抗生素治疗,修订MEDS(≥11),修订的新闻(≥6),并修订了qSOFA(≥3)。
BACKGROUND: The mortality rate of afebrile bacteremia has been reported to be as high as 45%. This investigation focused on the risk factors and predictive performance of scoring systems for the clinical outcomes of afebrile patients with monomicrobial gram-negative bacteria (GNB) in the emergency department (ED).
METHODS: We conducted a retrospective analysis of afebrile adult ED patients with monomicrobial GNB bacteremia from January 2012 to December 2021. We dissected the demographics, clinical pictures, and laboratory investigations. We applied five scoring systems and three revised systems to predict the clinical outcomes.
RESULTS: There were 600 patients included (358 males and 242 females), with a mean age of 69.6 ± 15.4 years. The overall mortality rate was 50.17%, reaching 68.52% (74/108) in cirrhotic patients. Escherichia coli was the leading pathogen (42.83%). The non-survivors had higher scores of the original MEDS (p < 0.001), NEWS (p < 0.001), MEWS (p < 0.001), qSOFA (p < 0.001), and REMS (p = 0.030). In univariate logistic regression analyses, several risk factors had a higher odds ratio (OR) for mortality, including liver cirrhosis (OR 2.541, p < 0.001), malignancy (OR 2.259, p < 0.001), septic shock (OR 2.077, p = 0.002), and male gender (OR 0.535, p < 0.001). The MEDS demonstrated that the best predictive power with the maximum area under the curve (AUC) was measured at 0.773 at the cut-off point of 11. The AUCs of the original NEWS, MEWS, qSOFA, and REMS were 0.663, 0.584, 0.572, and 0.553, respectively. We revised the original MEDS, NEWS, and qSOFA by adding red cell distribution width, albumin, and lactate scores and found a better predictive power of the AUC of 0.797, 0.719, and 0.694 on the revised MEDS ≥11, revised qSOFA ≥ 3, and revised NEWS ≥ 6, respectively.
CONCLUSIONS: The original MEDS, revised MEDS, revised qSOFA, and revised NEWS were valuable tools for predicting the mortality risk in afebrile patients with monomicrobial GNB bacteremia. We suggested that clinicians should explore patients with the risk factors mentioned above for possible severe infection, even in the absence of fever and initiate hemodynamic support and early adequate antibiotic therapy in patients with higher scores of the original MEDS (≥11), revised MEDS (≥11), revised NEWS (≥6), and revised qSOFA (≥3).