Tacconelli et al reported several scores for predicting mortality in a patient with sepsis, with scores for 14-day and 6-month mortality. Each temporal view has a quick and a full model. The authors are from multiple institutions in Germany and Italy participating in the DZIF BLOOMY study group.
BLOOMY is an acronym for Bloodstream Infection due to multidrug-resistant Organisms: Multicenter Study on Risk Factors and Clinical Outcomes.
Patient selection: hospitalized adult with >= 1 blood culture positive for Staphylococcus aureus, Enterococcus species, E. coli, Klebsiella species, Enterobacter species, Pseudomonas aeruginosa and Acinetobacter baumannii.
Outcome: 14-day mortality
Parameters:
(1) age in years and mechanical ventilation (MV)
(2) body mass index in kg per square meter
(3) pathogen
(4) eGFR in mL per min per 1.73 square meter
(5) length of stay/late hospital acquisition (late > 14 days)
(6) metastatic malignancy
(7) hypotension
(8) mental status
(9) WBC count per microliter
(10) platelet count per microliter
(11) serum CRP in mg/dL
|
Parameter
|
Finding
|
Points
|
|
age in years and MV
|
< 80 years
|
0
|
|
|
>= 80 years, no MV
|
1
|
|
|
>= 80 years, on MV
|
3
|
|
BMI
|
< 20
|
1
|
|
|
>= 20
|
0
|
|
pathogen
|
Pseudomonas, aeruginosa, Enterococcus faecium, MRSA
|
1
|
|
|
other
|
0
|
|
eGFR
|
> 30
|
0
|
|
|
<= 30
|
2
|
|
late hospital acquisition
|
no
|
0
|
|
|
yes
|
2
|
|
metastatic malignancy
|
no
|
0
|
|
|
yes
|
1
|
|
hypotension
|
no
|
0
|
|
|
yes
|
1
|
|
mental status
|
normal
|
0
|
|
|
disoriented
|
2
|
|
|
stupor or coma
|
3
|
|
WBC count
|
< 30,000 per µL
|
0
|
|
|
>= 30,000 per µL
|
2
|
|
platelet count
|
> 50,000 per µL
|
0
|
|
|
<= 50,000 per µL
|
2
|
|
CRP
|
< 20 mg/dL
|
0
|
|
|
>= 20 mg/dL
|
2
|
where:
• The late acquisition parameter refers to > 14 days, but the score is for 14-day mortality.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
|
Total Score
|
Mortality Derivation
|
Mortality Validation
|
|
0 or 1
|
0.34%
|
0.85%
|
|
2 to 7
|
6.3%
|
12%
|
|
>= 8
|
45.5%
|
45.2%
|
Performance:
• The area under the ROC curve is 0.86.
