qPitt菌血症评分对尿路感染继发血流感染患者预后的预测价值分析

Predictive value analysis of qPitt score for the prognosis in patients with secondary bloodstream infection caused by urinary tract infection

目的分析qPitt菌血症评分对尿路感染继发血流感染患者预后的影响。方法回顾性分析2018年1月至2020年12月在本院收治的266例年龄≥18岁的尿路感染继发血流感染患者的病历资料,根据28 d预后情况将患者分为生存组(234例)和死亡组(32例)。筛选影响患者死亡的独立危险因素,并运用受试者工作特征(ROC)曲线评估qPitt菌血症评分对患者死亡的预测效能,将患者分为qPitt菌血症评分≥2分组(54例)和qPitt菌血症评分<2分组(212例),探讨不同亚组中初始抗菌药物治疗方案对患者死亡的影响。结果死亡组的入住重症监护病房(ICU)比例、冠心病、既往脑卒中、自身免疫性疾病等指标均高于生存组,而性别(女)、接受泌尿外科手术、住院时间、体温低于生存组,差异均有统计学意义(均P<0.05)。两组血培养病原菌构成比较,差异有统计学意义(P<0.001)。尿路感染继发真菌血流感染患者的病死率高于尿路感染继发革兰阴性菌血流感染患者(50.0%vs.8.7%,P<0.001),高于尿路感染继发革兰阳性菌血流感染患者(50.0%vs.19.2%,P=0.055)。尿路感染继发革兰阳性菌血流感染的病死率高于尿路感染继发革兰阴性菌血流感染患者(19.2%vs.8.7%,P=0.030)。qPitt菌血症评分对应的ROC曲线下面积(AUC)大于查尔森合并症指数,差异有统计学意义(P<0.014)。qPitt菌血症评分≥2分预测死亡的灵敏度为81.3%,特异度为88.0%,阳性预测值48.1%,阴性预测值97.2%。qPitt菌血症评分≥2分与患者死亡存在一定的一致性(P<0.001)。qPiit菌血症评分≥2分组初始应用碳青霉烯类抗菌药物的患者病死率较低(P=0.003),qPitt菌血症评分<2分组初始应用碳青霉烯类抗菌药物对病死率无明显影响(P=0.340)。结论尿路感染继发血流感染患者采用qPitt菌血症评分对患者死亡预测价值较高,并且对初始抗菌药物治疗方案的制定有一定的指导意义。

ObjectiveTo analyze the effect of qPitt bacteremia score on the prognosis of patients with secondary bloodstream infection caused by urinary tract infection.MethodsThe medical records of 266 patients aged≥18 years old with secondary bloodstream infection admitted to our hospital between January 2018 and December 2020 were retrospectively analyzed.The patients were categorized into a survival group(234 cases)and a death group(32 cases)based on their prognosis within 28 days.The study conducted an analysis of independent risk factors associated with mortality and assessed the predictive performance of the qPitt bacteremia score using receiver operating characteristics(ROC)curve.The patients were categorized into the group with a qPitt bacteremia score≥2(54 cases)and the group with a qPitt bacteremia score<2(212 cases).The boundary for the qPitt bacteremia score was set at 2 points,and we investigated the impact of initial antimicrobial therapy on mortality in different subgroups.ResultsIn the death group,the proportion of hospitalization in intensive care unit(ICU),coronary heart disease,previous stroke,autoimmune disease and other indicators were higher than those in the survival group,while the gender(female),urological surgery,length of stay,and body temperature were lower than those in the survival group,with statistical significance(all P<0.05).The composition of pathogenic bacteria in blood culture between the two groups was statistically significant(P<0.001).The mortality rate of secondary fungal bloodstream infection was higher than that of secondary gram-negative bloodstream infection(50.0%vs.8.7%,P<0.001)and higher than that of secondary gram-positive bloodstream infection(50.0%vs.19.2%,P=0.055).The mortality rate of secondary gram-positive urinary tract infection was higher than that of secondary gram-negative urinary tract infection(19.2%vs.8.7%,P=0.030).The AUC corresponding to the qPitt bacteremia score was greater than the Charson comorbidities index,and the difference was statistically significant(P<0.014).The sensitivity,specificity,positive predictive value(48.1%)and negative predictive value(97.2%)of qPitt bacteremia score≥2 for predicting death were 81.3%,88.0%,48.1%and 88.0%respectively.There was certain consistency between qPitt bacteremia score≥2 and death(P<0.001).Patients with qPiit bacteremia score≥2 who were initially treated with carbapenems had a low mortality rate(P=0.003),while those with qPitt bacteremia score<2 had no significant effect on mortality rate(P=0.340).ConclusionsThe utilization of the qPitt bacteremia score in patients with urinary tract infection secondary to bloodstream infection demonstrates a significant prognostic value for mortality,and provides valuable guidance for the development of initial antimicrobial therapy.