ECFC评分与qPitt菌血症评分在尿路感染继发血流感染中预测价值的对比

Comparative analysis of the predictive value of quick Pitt bacteremia score and early clinical failure criteria in secondary bloodstream infection caused by urinary tract infection

目的比较快速Pitt(quick Pitt,qPitt)菌血症评分及早期临床失败评价标准(early clinical failure criteria,ECFC)对尿路感染继发血流感染患者预后和死亡的预测价值。方法回顾性搜集2018年1月至2020年12月本院收治的年龄≥18岁尿路感染继发血流感染患者的病历资料,运用受试者工作特征(receiver operating characteristic,ROC)曲线评估qPitt菌血症评分、ECFC评分对不良预后和死亡的预测效能。结果共纳入266例患者,其中男性116例,女性150例,年龄27~91岁,平均年龄(63.92±14.52)岁,尿路感染继发血流感染血培养病原学构成为革兰阴性菌占比77.44%,革兰阳性菌占比19.55%,真菌占比3.01%。ECFC评分对死亡及不良预后的预测价值较好(ROC曲线下面积分别为0.964、0.772,P<0.001),qPitt菌血症评分对死亡及不良预后的预测价值一般(ROC曲线下面积分别为0.890、0.648,P<0.001)。一致性检验结果显示,ECFC≥2分对不良预后和死亡的预测价值较好(Kappa值分别为0.503、0.580)。对于qPitt≥2分且ECFC≥2分的患者,住院治疗72~96 h时应用碳青霉烯类抗菌药物治疗的死亡率明显降低(χ^(2)=6.769,P=0.014)。结论对于尿路感染继发血流感染患者,ECFC评分对死亡和不良预后的预测价值优于qPitt菌血症评分,ECFC≥2分作为临界值对死亡的预测具有一定的指导意义。

Objective:To compare the predictive value of qpitt score and ECFC in the prognosis and death of patients with secondary bloodstream infection caused by urinary tract infection.Methods:The medical record data of patients aged≥18 years with secondary bloodstream infection caused by urinary tract infection treated in our hospital from January 2018 to December 2020 were collected retrospectively.ROC curve was used to evaluate the predictive efficacy of qPitt score and ECFC for poor prognosis and death.Results:A total of 266 patients,116 males and 150 females,aged from 27 to 91 years,with an average age of(63.92±14.52)years,were included.The pathogens of blood culture accounted for 77.44% of Gram-negative bacteria,19.55% of Gram-positive bacteria and 3.01% of fungi.ECFC had good predictive value for death and poor prognosis(the areas under ROC curve were 0.964 and 0.772,respectively,P<0.001).The value of qpitt score in predicting death and poor prognosis was ordinary(the areas under ROC curve were 0.890 and 0.648,respectively,P<0.001).The results of consistency test showed that ECFC≥2 had good predictive value for poor prognosis and death(Kappa values were 0.503 and 0.580,respectively).For patients with qpitt≥2 and ECFC≥2,the mortality of carbapenem antibiotics used at 72-96 hours after admission was significantly reduced(χ^(2)=6.769,P=0.014).Conclusion:For patients with secondary bloodstream infection caused by urinary tract infection,ECFC is better than qPitt score in predicting death and adverse prognosis.ECFC≥2 as a critical value has some guiding significance in predicting death.