Universität zu Köln

Tacconelli, Evelina, Goepel, Siri, Gladstone, Beryl P., Eisenbeis, Simone, Hoelzl, Florian, Buhl, Michael, Gorska, Anna, Cattaneo, Chiara, Mischnik, Alexander, Rieg, Siegbert, Rohde, Anna M., Kohlmorgen, Britta ORCID: 0000-0001-5609-6142, Falgenhauer, Jane, Trauth, Janina ORCID: 0000-0002-1959-7295, Kaeding, Nadja, Kramme, Evelyn, Biehl, Lena M. ORCID: 0000-0001-7613-8119, Walker, Sarah, V, Peter, Silke, Gastmeier, Petra, Chakraborty, Trinad, Vehreschild, Maria J. G. T., Seifert, Harald, Rupp, Jan ORCID: 0000-0001-8722-1233 and Kern, Winfried, V (2022). Development and validation of BLOOMY prediction scores for 14-day and 6-month mortality in hospitalised adults with bloodstream infections: a multicentre, prospective, cohort study. Lancet Infect. Dis., 22 (5). S. 731 - 742. OXFORD: ELSEVIER SCI LTD. ISSN 1474-4457

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Abstract

Background The burden of bloodstream infections remains high worldwide and cannot be confined to short-term in-hospital mortality. We aimed to develop scores to predict short-term and long-term mortality in patients with bloodstream infections. Methods The Bloodstream Infection due to Multidrug-resistant Organisms: Multicenter Study on Risk Factors and Clinical Outcomes (BLOOMY) study is a prospective, multicentre cohort study at six German tertiary care university hospitals to develop and validate two scores assessing 14-day and 6-month mortality in patients with bloodstream infections. We excluded patients younger than 18 years or who were admitted to an ophthalmology or psychiatry ward. Microbiological, clinical, laboratory, treatment, and survival data were prospectively collected on day 0 and day 3 and then from day 7 onwards, weekly. Participants were followed up for 6 months. All patients in the derivation cohort who were alive on day 3 were included in the analysis. Predictive scores were developed using logistic regression and Cox proportional hazards models with a machine-learning approach. Validation was completed using the C statistic and predictive accuracy was assessed using sensitivity, specificity, and predictive values. Findings Between Feb 1,2017, and Jan 31,2019,2568 (61.5%) of 4179 eligible patients were recruited into the derivation cohort. The in-hospital mortality rate was 23.75% (95% CI 22.15-25.44; 610 of 2568 patients) and the 6-month mortality rate was 41.55% (39.54-43-59; 949 of 2284). The model predictors for 14-day mortality (C statistic 0.873, 95% CI 0.849-0-896) and 6-month mortality (0.807, 0.784-0-831) included age, body-mass index, platelet and leukocyte counts, C-reactive protein concentrations, malignancy (ie, comorbidity), in-hospital acquisition, and pathogen. Additional predictors were, for 14-day mortality, mental status, hypotension, and the need for mechanical ventilation on day 3 and, for 6-month mortality, focus of infection, in-hospital complications, and glomerular filtration rate at the end of treatment. The scores were validated in a cohort of 1023 patients with bloodstream infections, recruited between Oct 9,2019, and Dec 31, 2020. The BLOOMY 14-day score showed a sensitivity of 61.32% (95% CI 51.81-70.04), a specificity of 86.36% (83.80-88.58), a positive predictive value (PPV) of 37.57% (30.70-44.99), and a negative predictive value (NPV) of 94.35% (92.42-95.80). The BLOOMY 6-month score showed a sensitivity of 69.93% (61.97-76.84), a specificity of 66.44% (61.86-70-73), a PPV of 40.82% (34.85-47-07), and a NPV of 86.97% (82.91-90.18). Interpretation The BLOOMY scores showed good discrimination and predictive values and could support the development of protocols to manage bloodstream infections and also help to estimate the short-term and long-term burdens of bloodstream infections. Copyright (C) 2022 Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Tacconelli, Evelina UNSPECIFIED UNSPECIFIED UNSPECIFIED Goepel, Siri UNSPECIFIED UNSPECIFIED UNSPECIFIED Gladstone, Beryl P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Eisenbeis, Simone UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoelzl, Florian UNSPECIFIED UNSPECIFIED UNSPECIFIED Buhl, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Gorska, Anna UNSPECIFIED UNSPECIFIED UNSPECIFIED Cattaneo, Chiara UNSPECIFIED UNSPECIFIED UNSPECIFIED Mischnik, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Rieg, Siegbert UNSPECIFIED UNSPECIFIED UNSPECIFIED Rohde, Anna M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kohlmorgen, Britta UNSPECIFIED orcid.org/0000-0001-5609-6142 UNSPECIFIED Falgenhauer, Jane UNSPECIFIED UNSPECIFIED UNSPECIFIED Trauth, Janina UNSPECIFIED orcid.org/0000-0002-1959-7295 UNSPECIFIED Kaeding, Nadja UNSPECIFIED UNSPECIFIED UNSPECIFIED Kramme, Evelyn UNSPECIFIED UNSPECIFIED UNSPECIFIED Biehl, Lena M. UNSPECIFIED orcid.org/0000-0001-7613-8119 UNSPECIFIED Walker, Sarah, V UNSPECIFIED UNSPECIFIED UNSPECIFIED Peter, Silke UNSPECIFIED UNSPECIFIED UNSPECIFIED Gastmeier, Petra UNSPECIFIED UNSPECIFIED UNSPECIFIED Chakraborty, Trinad UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, Maria J. G. T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Seifert, Harald UNSPECIFIED UNSPECIFIED UNSPECIFIED Rupp, Jan UNSPECIFIED orcid.org/0000-0001-8722-1233 UNSPECIFIED Kern, Winfried, V UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-693240
DOI:	10.1016/S1473-3099(21)00587-9
Journal or Publication Title:	Lancet Infect. Dis.
Volume:	22
Number:	5
Page Range:	S. 731 - 742
Date:	2022
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	1474-4457
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language FAILURE ASSESSMENT SCORE; INTENSIVE-CARE-UNIT; EMERGENCY-DEPARTMENT; SEPSIS; BACTEREMIA Multiple languages Infectious Diseases Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/69324