Abstract
BackgroundFew mortality-scoring models are available for solid tumor patients who are predisposed to develop Escherichia coli–caused bloodstream infection (ECBSI). We aimed to develop a mortality-scoring model by using information from blood culture time to positivity (TTP) and other clinical variables.MethodsA cohort of solid tumor patients who were admitted to hospital with ECBSI and received empirical antimicrobial therapy was enrolled. Survivors and non-survivors were compared to identify the risk factors of in-hospital mortality. Univariable and multivariable regression analyses were adopted to identify the mortality-associated predictors. Risk scores were assigned by weighting the regression coefficients with corresponding natural logarithm of the odds ratio for each predictor.ResultsSolid tumor patients with ECBSI were distributed in the development and validation groups, respectively. Six mortality-associated predictors were identified and included in the scoring model: acute respiratory distress (ARDS), TTP ≤ 8 h, inappropriate antibiotic therapy, blood transfusion, fever ≥ 39 °C, and metastasis. Prognostic scores were categorized into three groups that predicted mortality: low risk (< 10% mortality, 0–1 points), medium risk (10–20% mortality, 2 points), and high risk (> 20% mortality, ≥ 3 points). The TTP-incorporated scoring model showed excellent discrimination and calibration for both groups, with AUC being 0.833 vs 0.844, respectively, and no significant difference in the Hosmer–Lemeshow test (6.709, P = 0.48) and the chi-square test (6.993, P = 0.46). Youden index showed the best cutoff value of ≥ 3 with 76.11% sensitivity and 79.29% specificity. TTP-incorporated scoring model had higher AUC than no TTP-incorporated model (0.837 vs 0.817, P < 0.01).ConclusionsOur TTP-incorporated scoring model was associated with improving capability in predicting ECBSI-related mortality. It can be a practical tool for clinicians to identify and manage bacteremic solid tumor patients with high risk of mortality.
Highlights
Advances in surgery combined with targeted or chemotherapies have substantially improved the survival rate of solid tumor patients
We showed that time to positivity (TTP) was a dominant predictor for in-hospital mortality in solid tumor patients with Escherichia coli–caused bloodstream infection (ECBSI) (Table 2)
Unlike the hematologically malignant (HM) patients with bacteremia, among those ICU admission, ESBL and neutropenia are the frequent predictors of ECBSI-caused mortality [9, 24]
Summary
Advances in surgery combined with targeted or chemotherapies have substantially improved the survival rate of solid tumor patients. Because of baseline immunodeficiency, cytotoxic treatments, and frequent invasive procedures, solid tumor patients are at high risk of bloodstream infection (BSI). An estimated 5.5–16.4‰ of solid tumor patients developed BSI [1], which pose significant burden on healthcare institutions as well as patients’ families. Multidrug-resistant EC (e.g., extended-spectrum-beta-lactamase, ESBL) has spread in recent decades, and became a major health problem worldwide This problem is of particular concern among solid tumor patients with immunosuppressed status, who are at high risk of severe sepsis and with BSI-related mortality. Few mortality-scoring models are available for solid tumor patients who are predisposed to develop Escherichia coli–caused bloodstream infection (ECBSI). Conclusions Our TTP-incorporated scoring model was associated with improving capability in predicting ECBSI-related mortality. It can be a practical tool for clinicians to identify and manage bacteremic solid tumor patients with high risk of mortality
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