Xu et al reported a prediction model for presence of a bloodstream infection (BSI) in a patient with fever of unknown origin (FUO). The authors are from Fudan University and the National Health and Family Planning Commission in Shanghai.
Patient selection: fever of unknown origin
Parameters:
(1) diabetes mellitus
(2) chills
(3) serum CRP in mg/L
(4) serum procalcitonin in ng/mL
(5) percentage neutrophils in the differential count
Parameter
Finding
Points
diabetes mellitus
no
0
yes
1.5
chills
absent
0
present
1
serum CRP
<= 50 mg/L
0
51 to 100 mg/L
1
> 100 mg/L
0
serum procalcitonin
<= 0.3 mg/mL
0
> 0.3 ng/mL
1.5
percentage neutrophils
<= 75%
0
> 75%
l
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• A score < 1.5 has a 2% chance of having a bloodstream infection.
• A score >= 4.5 has a chance of 48% for having a bloodstream infection.
Performance:
• The area under the ROC curve is 0.85.
• The negative predictive value was high (0.97) while the positive predictive value was low (0.23).
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