Abstract
BackgroundAutomated laboratory-based prediction models may support clinical decisions in Staphylococcus aureus bloodstream infections (BSIs), which carry a particularly high mortality. Small studies indicated that the laboratory-based Model for End-stage Liver Disease (MELD) score is a risk factor for mortality in critically ill patients with infections. For S. aureus BSIs, we therefore aimed to assess a potential association of the MELD score with mortality.MethodsIn this single-centre observational study, all consecutive patients with a first episode of methicillin-susceptible S. aureus BSI occurring between 2001 and 2013 were eligible. Relevant patient data were retrieved from our prospective in-house BSI database. We assessed the association of the MELD score at day of BSI onset (range ± two days) with 30-day all-cause mortality using uni- and multivariable logistic regression analysis.Results561 patients were included in the final analysis. The MELD score at BSI onset was associated with 30-day mortality in S. aureus BSIs (odds ratio per 1-point increase, 1.06; 95% confidence interval, 1.03‒1.09; P < 0.001). After adjustment for relevant patient and infection characteristics, an increased MELD score remained a predictor of 30-day mortality (adjusted odds ratio per 1-point increase, 1.05; 95% confidence interval, 1.01‒1.08; P = 0.005).ConclusionsIn our study population, the MELD score at BSI onset was an independent predictor of mortality in S. aureus BSIs. We therefore suggest to prospectively validate the MELD score as part of clinical decision support systems in inpatients with suspected or confirmed BSI.
Highlights
Staphylococcus aureus is a leading cause of bloodstream infection (BSI) carrying a high mortality, even if treated with adequate antimicrobial and supportive measures [1, 2]
The Model for End-stage Liver Disease (MELD) score at BSI onset was associated with 30-day mortality in S. aureus BSIs
After adjustment for relevant patient and infection characteristics, an increased MELD score remained a predictor of 30-day mortality
Summary
Staphylococcus aureus is a leading cause of bloodstream infection (BSI) carrying a high mortality, even if treated with adequate antimicrobial and supportive measures [1, 2]. The considerable mortality stresses the importance of prediction models to support clinical decisions in S. aureus BSIs. The Model for End-stage Liver Disease (MELD) is a widely-used risk model, which was initially created to predict mortality in patients with portal hypertension undergoing placement of transjugular intrahepatic portosystemic shunts [3]. The Model for End-stage Liver Disease (MELD) is a widely-used risk model, which was initially created to predict mortality in patients with portal hypertension undergoing placement of transjugular intrahepatic portosystemic shunts [3] It was thoroughly validated as a predictor of mortality among different patient populations across a broad spectrum of liver diseases—primarily to allocate organs for liver transplantation [4,5,6]. Small studies indicated that the laboratory-based Model for End-stage Liver Disease (MELD) score is a risk factor for mortality in critically ill patients with infections. For S. aureus BSIs, we aimed to assess a potential association of the MELD score with mortality
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