Yeh et al reported a PIRO (predisposition, infection, response, organ dysfunction) model for a patient with a bloodstream infection. This can help to identify a patient who may benefit from more aggressive management. The authors are from Chang Gung University in Taiwan.
Patient selection: bacteremia
Outcome: 28-day mortality
PIRO components:
(1) predisposition: malignancy
(2) infections: pneumonia, S. aureus bacteremia, unknown focus
(3) response: body temperature in °C, band form in percent, RDW in percent
(4) organ dysfunction: percutaneous oxygen saturation in percent, serum creatinine in mg/dL
Parameter
Finding
Points
malignancy
absent
0
present
2
pneumonia
absent
0
present
4
Staph. aureus bacteremia
absent
0
present
2
focus
known
0
unknown
2
body temperature
< 36°C
3
>= 36°C
0
percent band forms
<= 5%
0
> 5%
3
RDW in percent
<= 15%
0
> 15%
2
SpO2 in percent
>= 90%
0
< 90%
2
serum creatinine
<= 2 mg/dL
0
> 2 mg/dL
2
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 22
• The higher the score the more severe the infection.
Score
Risk Group
28-Day Mortality Rate
0 to 3
low
1.5%
4 to 6
moderate
10.5%
7 or 8
high
29%
>= 9
very high
66%
Performance:
• The area under the ROC curve is 0.88.
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