Performance of Scoring Systems in Predicting Clinical Outcomes in Patients with Bacteremia of Listeria monocytogenes: A 9-Year Hospital-Based Study

Abstract

Background: Listeria monocytogenes (LM) is a facultative anaerobe, Gram-positive bacillus which is widely distributed in nature, and can be separated from soil, water, and rotten vegetables. Immunocompetent people are less likely to suffer from LM infection or may only show gastrointestinal symptoms. However, immunocompromised elderly people, pregnant women, and newborns may develop life-threatening invasive infections. The mortality rate of LM infection is as high as 25–30%. The aim of this study is to investigate clinical scores of patients with bacteremia of LM confirmed by one or more blood cultures. We analyzed their demographics and laboratory findings in relation to their clinical outcomes. Materials and Methods: This was a hospital-based retrospective study on patients with bacteremia of LM. Data were collected from the electronic clinical database of Taichung Veterans General Hospital between January 2012 and December 2020. Bacteremia of LM was confirmed by at least one blood culture. Demographics, clinical characteristics, and laboratory data were collected for analysis. A variety of clinical scoring systems were used to predict the clinical outcome. Results: A total of 39 patients had confirmed bacteremia of LM. Among them, 1 neonatal patient was excluded. The remaining 38 patients were studied. They included 16 males (42.1%) and 22 females (57.9%), with a mean age of 59.9 ± 19.6 years. Their hospital stay averaged 23.3 ± 20.9 days. The in-hospital mortality rate was 36.8%. Mortality in Emergency Department Sepsis (MEDS) Score was 6.6 ± 4.0 for survivors and 12.4 ± 4.4 for non-survivors (P < 0.001). The National Early Warning Score (NEWS) was 3.9 ± 2.8 for survivors and 7.8 ± 3.1 for non-survivors (P = 0.001). Regarding the prediction of mortality risk, the AUC of ROC was 0.829 for MEDS and 0.815 for NEWS. Conclusions: MEDS and NEWS were both good predictors of the clinical outcome in LM bacteremic patients. In those with higher scores of MEDS (≥10) and NEWS (≥8), we recommended an early goal-directed therapy and appropriate antibiotic treatment as early as possible to reduce mortality. Further large-scale studies are required to gain a deeper understanding of this disease and to ensure patient safety.

Predictive Performance of Scoring Systems for Mortality Risk in Patients with Cryptococcemia: An Observational Study

“…The AUC of ROC of MEDS was 0.905 at the cut-off point of 4, with a sensitivity of 92.6% (25/27) and specificity of 80% (12/15), respectively. However, we found a lower cut-off point than other studies [ 27 , 28 , 34 ]. The possible causes were the presence of no patients with nursing home residence or terminal illness conditions and no band portion >5% in our study.…”

“…Shapiro et al developed the MEDS score initially according to the odds ratio of mortality risk in ED patients with a chance of sepsis in 2003. In Taiwan, many authors applied the MEDS score to predict the severity and mortality rate of patients with bacteremia [ 27 , 28 , 33 ].…”

“…In recent studies, they applied various simple scoring systems ( Supplementary Materials ), including quick the Sequential Organ Failure Assessment (qSOFA) Score, Rapid Acute Physiology Score (RPAS), Mortality in Emergency Department Sepsis (MEDS) score, Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and Rapid Emergency Medicine Score (REMS), to become the predictors of clinical outcomes for critical illness. However, they did not apply these in the survey of cryptococcemia [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Therefore, we analyzed the risk factors for patients with cryptococcemia and the impact of mortality rate by different origins of cryptococcal infection, clinical characteristics, and the performance of the abovementioned scoring systems.…”

Scoring Systems to Evaluate the Mortality Risk of Patients with Emphysematous Cystitis: A Retrospective Observational Study

“…It is also widely used to predict the mortality risk for patients with community-acquired bacteremia in Taiwan. In a recent study, the REMS score was applied to patients with COVID-19 and influenced its risk stratification [ 34 , 35 , 36 , 37 , 38 ]. Olsson et al created the REMS score in 2004 and the parameters were listed in Table 7 .…”

Performance of Scoring Systems in Predicting Clinical Outcomes of Patients with Emphysematous Pyelonephritis: A 14-Year Hospital-Based Study

“…The Glasgow Admission Prediction Score (GAPS), Mortality in Emergency Department Sepsis (MEDS) score, Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), quick Sepsis Related Organ Failure Assessment (qSOFA), and Worthing Physiological Scoring system (WPS) are the different scoring systems, consisting of various available clinical parameters, used to predict the clinical outcomes of patients in emergency and critical care [10][11][12][13][14][15]. Due to the low incidence but high mortality rate of EPN, we aimed to validate the performance of various scoring systems (n = 8) in assessing the severity and clinical outcomes of EPN.…”