AUTHOR=Duan Xiaoguang , Zhang Ruifang , Zhang Xiaojuan , Ding Xianfei , Sun Tongwen TITLE=Identification of Prognostic Factors in Patients With Streptococcus Bloodstream Infection JOURNAL=Frontiers in Medicine VOLUME=9 YEAR=2022 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.832007 DOI=10.3389/fmed.2022.832007 ISSN=2296-858X ABSTRACT=Aim

The purpose of this study was to explore prognostic factors of bloodstream infections (BSIs), a common severe infection and a major cause of mortality worldwide, so as to construct a prognosis model of patients with BSI.

Materials and Methods

Clinical and biochemical test data were obtained retrospectively from the medical records of 562 patients with BSI who had been treated at a single center; the end point was 60 days of all-cause death. The chi-square test was used to compare the mortality of patients grouped by the types of antibiotic treatment. The logistic regression analysis was adopted to identify prognostic factors; the Kaplan–Meier survival curve and log-rank test were conducted to compare the survival rate of patients with different prognostic factors; the receiver operating characteristic (ROC) curve was used to estimate the predictive value of different prognostic factors.

Results

Of the 562 patients, 455 survived (80.96%), and 107 died (19.04%). The mortality rate of patients treated with a combination of antibiotics (25.40%) was higher than that treated with a single antibiotic (15.82%). Univariate analysis identified 19 prognostic factors for patients with BSI, including gender, age, diabetes, malignant tumor (non-blood system), total hospitalization time, alanine aminotransferase, aspartate aminotransferase, total protein, albumin, total bilirubin, direct bilirubin, creatinine, ratio of granulocytes, fibrinogen, D-dimer, platelet, C-reactive protein, shock, and respiratory failure (P < 0.05). Multivariate analysis indicated that albumin (odds ratio [OR] = 0.94, 95% confidence interval [CI]: 0.89–0.99), fibrinogen (OR = 0.61, 95%CI: 0.46–0.82), shock (OR = 16.61, 95%CI: 7.00–39.41), and respiratory failure (OR = 47.53, 95%CI: 19.93–133.64) were independent factors. The combination of four indicators demonstrated a favorable predictive value for the 60-day outcome of patients with BSI, with an area under the ROC of 0.96 (95%CI: 0.94–0.99), sensitivity of 90.65%, specificity of 94.95%, and accuracy of 94.13%.

Conclusions

Shock, respiratory failure, albumin, and fibrinogen are potential independent prognostic factors for 60-day mortality.