Clinical characteristics, organ failure, inflammatory markers and prediction of mortality in patients with community acquired bloodstream infection

Abstract

BackgroundCommunity acquired bloodstream infection (CABSI) in low- and middle income countries is associated with a high mortality. This study describes the clinical manifestations, laboratory findings and correlation of SOFA and qSOFA with mortality in patients with CABSI in northern Vietnam.MethodsThis was a retrospective study of 393 patients with at least one positive blood culture with not more than one bacterium taken within 48 h of hospitalisation. Clinical characteristic and laboratory results from the first 24 h in hospital were collected. SOFA and qSOFA scores were calculated and their validity in this setting was evaluated.ResultsAmong 393 patients with bacterial CABSI, approximately 80% (307/393) of patients had dysfunction of one or more organ on admission to the study hospital with the most common being that of coagulation (57.1% or 226/393). SOFA performed well in prediction of mortality in those patients initially admitted to the critical care unit (AUC 0.858, 95%CI 0.793–0.922) but poor in those admitted to medical wards (AUC 0.667, 95%CI 0.577–0.758). In contrast qSOFA had poor predictive validity in both settings (AUC 0.692, 95%CI 0.605–0.780 and AUC 0.527, 95%CI 0.424–0.630, respectively). The overall case fatality rate was 28%. HIV infection (HR = 3.145, p = 0.001), neutropenia (HR = 2.442, p = 0.002), SOFA score 1-point increment (HR = 1.19, p < 0.001) and infection with Enterobacteriaceae (HR = 1.722, p = 0.037) were independent risk factors for in-hospital mortality.ConclusionsOrgan dysfunction was common among Vietnamese patients with CABSI and associated with high case fatality. SOFA and qSOFA both need to be further validated in this setting.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3448-3) contains supplementary material, which is available to authorized users.

Prevalence of organ failure and mortality among patients in the emergency department: a population-based cohort study

“…Furthermore, cerebral failure, as in our study, had the strongest association with short-term mortality, followed by respiratory and circulatory failure, the latter in contrast to our study, and hepatic and cerebral failure were associated with long-term mortality 14. In organ failure patients with positive blood culture, the highest in-hospital mortality was observed in patients with circulatory failure followed by respiratory and cerebral 15. At the ICU, the in-hospital mortality is described around 35% and 1-year mortality around 45%7 13 which is higher than our findings, and in contrast to our numbers, hepatic failure is described with highest short-term risk of death, but in accordance with our study respiratory has the lowest short-term mortality 6 13.…”

“…Furthermore, organ failure affects not only in-hospital prognosis but also long-term morbidity and mortality 12–14. In addition, different prevalences are described for different organ failures, and the mortality varies by organ failure and number of organ failures 15–17. These studies are less useful for the public health planning as well as upfront clinical evaluations and decisions, because patients included are selected, and might be considerable different from the very diverse acutely ill patients identified and treated upon arrival to the ED.…”

Characteristics and Risk Factors Associated with Early Mortality in Patients with Polymicrobial Bloodstream Infection: A Retrospective Clinical Study

“…Multiorgan dysfunction is common in patients with BSI. It was reported that the SOFA performed well in predicting organ dysfunction in some patients with BSI (24). However, no previous study has considered the SOFA score in patients with PBSI.…”

“…Besides, we also evaluated some prognostic systems, which have been reported link with mortality of patients with BSI (24,25). We found that the SOFA ,APACHE II and SAPS II all had good predictive accuracy in our study.…”

Pathophysiologic Signatures of Bloodstream Infection in Critically Ill Adults

“…Bloodstream infection (BSI) is associated with a high risk of mortality ( 1 – 3 ). This is especially true in critically ill patients, in whom BSI has reported mortality rates of 30–47% ( 4 – 7 ). Clinical signs and symptoms of BSI are nonspecific, and published guidelines do not provide clear indications for when it is most appropriate to obtain blood cultures ( 8 ).…”