Added value of clinical prediction rules for bacteremia in hemodialysis patients: An external validation study

Abstract

Introduction Having developed a clinical prediction rule (CPR) for bacteremia among hemodialysis (HD) outpatients (BAC-HD score), we performed external validation. Materials & methods Data were collected on maintenance HD patients at two Japanese tertiary-care hospitals from January 2013 to December 2015. We enrolled 429 consecutive patients (aged ≥ 18 y) on maintenance HD who had had two sets of blood cultures drawn on admission to assess for bacteremia. We validated the predictive ability of the CPR using two validation cohorts. Index tests were the BAC-HD score and a CPR developed by Shapiro et al. The outcome was bacteremia, based on the results of the admission blood cultures. For added value, we also measured changes in the area under the receiver operating characteristic curve (AUC) using logistic regression and Net Reclassification Improvement (NRI), in which each CPR was added to the basic model. Results In Validation cohort 1 (360 subjects), compared to a Model 1 (Basic Model) AUC of 0.69 (95% confidence interval [95% CI]: 0.59–0.80), the AUC of Model 2 (Basic model + BAC-HD score) and Model 3 (Basic model + Shapiro’s score) increased to 0.8 (95% CI: 0.71–0.88) and 0.73 (95% CI: 0.63–0.83), respectively. In validation cohort 2 (96 subjects), compared to a Model 1 AUC of 0.81 (95% CI: 0.68–0.94), the AUCs of Model 2 and Model 3 increased to 0.83 (95% CI: 0.72–0.95) and 0.85 (95% CI: 0.76–0.94), respectively. NRIs on addition of the BAC-HD score and Shapiro’s score were 0.3 and 0.06 in Validation cohort 1, and 0.27 and 0.13, respectively, in Validation cohort 2. Conclusion Either the BAC-HD score or Shapiro’s score may improve the ability to diagnose bacteremia in HD patients. Reclassification was better with the BAC-HD score.

Association between serum alkaline phosphatase and bacteraemia in haemodialysis outpatients: a multicentre retrospective cross-sectional study

“…We need to decide the timing of administration of therapy and choice of antimicrobial agents appropriately. Serum ALP levels have been reported as one example of a simple clinical prediction rule in the bacteraemia ‘BAC-HD score’ 43. In maintenance HD outpatients suspected of sepsis, elevated serum ALP levels may indicate the presence of bacteraemia and may aid in the decision to begin early antimicrobial therapy and in the choice of the antimicrobial agent.…”

New predictive models of bacteremia in the emergency department: a step forward

“…En realidad, en los últimos años se han publicado distintos modelos predictivos de BV en pacientes con ITU [77][78][79], pero todos ellos tienen una muestra muy limitada (menos de 400 pacientes con ITU) y unos resultados significativamente menores a los comentados anteriormente cuando se analizan los subgrupos de pacientes con ITU en los modelos 5MPB-Toledo [52] y MPB-INFURG-SEMES [59], por lo que no pueden ser recomendados de forma generalizada. Incluso alguno de ellos se ha comparado con el modelo de Shapiro obteniendo peores resultados que éste [78].…”

“…En realidad, en los últimos años se han publicado distintos modelos predictivos de BV en pacientes con ITU [77][78][79], pero todos ellos tienen una muestra muy limitada (menos de 400 pacientes con ITU) y unos resultados significativamente menores a los comentados anteriormente cuando se analizan los subgrupos de pacientes con ITU en los modelos 5MPB-Toledo [52] y MPB-INFURG-SEMES [59], por lo que no pueden ser recomendados de forma generalizada. Incluso alguno de ellos se ha comparado con el modelo de Shapiro obteniendo peores resultados que éste [78]. En relación a la utilidad del modelo 5MPB-Toledo en los pacientes con ITU (resultados no publicados de los autores) en una muestra de 1.499 episodios con 277 BV (18,5%) el ABC-COR del modelo fue de 0,937 (IC 95%:0,926-0,949) y el rendimiento diagnóstico del modelo con un PC ≥5 puntos consigue una S de 97,47% (IC 95%: 94,64-98,89), E de 76,68% (IC 95%: 74,18-79,00) y un VPN de 99,26% (IC 95%: 98,41-99,67).…”

Clinical Characteristics and In-Hospital Outcomes in Dialysis Patients with Septic Arthritis

“…The elevated incidence of septic arthritis in dialysis patients is likely to be the consequence of compromised cellular and humoral immunity and frequent exposure to urinary and vascular access, which increases the risk of bloodstream infection [ 9 ]. Compared to the general population, dialysis patients with bacteremia are susceptible to higher morbidity and mortality [ 10 ]. However, the prognostic factors for in-hospital outcomes in dialysis patients with septic arthritis have yet to be identified in the current literature.…”