Predictive performance of comorbidity for 30-day and 1-year mortality in patients with bloodstream infection visiting the emergency department: a retrospective cohort study

ObjectivesTo investigate whether the Charlson Comorbidity Index (CCI) predicted short-term and long-term mortality in patients with a bloodstream infection visiting the emergency department (ED) and compare it to the often-validated National Early Warning Score (NEWS).DesignA retrospective cohort st...

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Veröffentlicht in:BMJ open Jg. 12; H. 4; S. e057196
Hauptverfasser: Schuttevaer, Romy, Boogers, William, Brink, Anniek, van Dijk, Willian, de Steenwinkel, Jurriaan, Schuit, Stephanie, Verbon, Annelies, Lingsma, Hester, Alsma, Jelmer
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England British Medical Journal Publishing Group 06.04.2022
BMJ Publishing Group LTD
BMJ Publishing Group
Schriftenreihe:Original research
Schlagworte:
Acquired immune deficiency syndrome
Adult
Age
AIDS
Area Under Curve
BACTERIOLOGY
Clinical medicine
Cohort analysis
Comorbidity
Connective tissue diseases
Dementia
Diabetes
Emergency Service, Hospital
Epidemiology
Heart attacks
Heart failure
HIV
Hospital Mortality
Human immunodeficiency virus
Humans
Hypertension
Infections
Infectious Diseases
INTERNAL MEDICINE
Ischemia
Kidney diseases
Leukemia
Liver diseases
Lymphoma
Metastasis
MICROBIOLOGY
Mortality
Patients
Retrospective Studies
Sepsis
Transient ischemic attack
Ulcers
Vital signs
BACTERIOLOGY
INFECTIOUS DISEASES
MICROBIOLOGY
Epidemiology
INTERNAL MEDICINE
ISSN:2044-6055, 2044-6055
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Zusammenfassung:ObjectivesTo investigate whether the Charlson Comorbidity Index (CCI) predicted short-term and long-term mortality in patients with a bloodstream infection visiting the emergency department (ED) and compare it to the often-validated National Early Warning Score (NEWS).DesignA retrospective cohort study.SettingA tertiary hospital in the Netherlands.ParticipantsAdult patients attending the ED with a blood culture-proven infection between 2012 and 2017 were included. We collected the comorbidities from the CCI and the vital signs from the NEWS.Main outcomesShort-term mortality (30-day) and long-term mortality (1 year). We assessed the predictive performance by discrimination, expressed as the area under the curve (AUC).ResultsWe included 1039 patients with a blood culture-proven infection. Mortality was 10.4% within 30 days and 27.8% within 1 year. On average patients had two comorbidities (ranging from 0 to 6). Highly prevalent comorbidities were malignancy (30.2%) and diabetes mellitus (20.5%). The predictive performance of the CCI was highest for 1-year mortality (AUC 0.696 (95%CI) (0.660 to 0.732)) and better compared with the NEWS (AUC (95% CI) 0.594 (0.555 to 0.632)). For prediction of 30-day mortality, the NEWS was superior (AUC (95% CI) 0.706 (0.656 to 0.756)) to the comorbidities of the CCI (AUC (95% CI) 0.568 (0.507 to 0.628)).ConclusionsWe found that presenting comorbidity (ie, the CCI) is most useful to prognosticate long-term outcome in patients with bloodstream infection in the ED. Short-term mortality is more accurately predicted by deviating vital signs (ie, the NEWS).
Bibliographie:Original research
ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2021-057196