A Visualized Mortality Prediction Score Model in Hematological Malignancies Patients with Carbapenem-Resistant Organisms Bloodstream Infection

• Published in: Infection and drug resistance 2023-01, Vol.16, p.201-215
• Main Authors: Qian, Chenjing, Wu, Qiuling, Ruan, Zhixuan, Liu, Fang, Li, Weiming, Shi, Wei, Ma, Ling, Peng, Danyue, Yin, Hua, Yao, Lan, Li, Zixuan, Hong, Mei, Xia, Linghui
• Format: Article
• Language: English
• Subjects: Antibiotics; Bacteria; bloodstream infection; C-reactive protein; Cancer; Cancer patients; carbapenem-resistant organisms; Carbapenems; China; Comparative analysis; Drug resistance; hematological malignancies; Hematology; Infection; Intubation; Laboratories; Length of stay; Malignancy; Medical prognosis; Medical research; Medicine, Experimental; Methicillin; Mortality; Mucositis; Multivariate analysis; Neutropenia; Neutrophils; nomogram; Nomograms; Original Research; Patient outcomes; Polymyxin B; Predictions; predictive model; Risk factors; Risk groups; Software; Staphylococcus infections; Tigecycline; Variables
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S393932

Bloodstream infection (BSI) due to carbapenem-resistant organisms (CROs) has emerged as a worldwide problem associated with high mortality. This study aimed to evaluate the risk factors associated with mortality in HM patients with CROs BSI and to establish a scoring model for early mortality prediction. We conducted a retrospective cohort study at our hematological department from January 2018 to December 2021, including all HM patients with CROs BSI. The outcome measured was death within 30-day of BSI onset. Survivor and non-survivor subgroups were compared to identify predictors of mortality. Univariate and multivariate Cox regression analyses were used to identify prognostic risk factors and develop a nomogram. In total, 150 HM patients were included in the study showing an overall 30-day mortality rate of 56%. was the dominant episode. Cox regression analysis showed that pre-infection length of stay was >14 days (score 41), Pitt score >4 (score 100), mucositis (score 41), CAR (The ratio of C-reactive protein to albumin) >8.8 (score 57), early definitive therapy (score 44), and long-duration (score 78) were positive independent risk predictors associated with 30-day mortality, all of which were selected into the nomogram. Furthermore, all patients were divided into the high-risk group (≥160 points) or the low-risk group based on the prediction score model. The mortality of the high-risk group was 8 times more than the low-risk group. Kaplan-Meier analysis showed that empirical polymyxin B therapy was associated with a lower 30-day mortality rate, which was identified as a good prognostic factor in the high-risk group. In comparison, empirical carbapenems and tigecycline were poor prognostic factors in a low-risk group. Our score model can accurately predict 30-day mortality in HM patients with CROs BSI. Early administration of CROs-targeted therapy in the high-risk group is strongly recommended to decrease mortality.