Prediction of 30-Day Mortality Using the Quick Pitt Bacteremia Score in Hospitalized Patients with Klebsiella pneumoniae Infection

Abstract

Ching Su,1 I-Ting Tsai,1,2 Chung-Hsu Lai,2,3 Kuo-Hsuan Lin,1 Chia‐Chi Chen,2,4 Yin-Chou Hsu1,2,5– 7 1Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, 82445, Taiwan; 2School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 3Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, 82445, Taiwan; 4Department of Pathology, E-Da Hospital, I-Shou University, Kaohsiung City, 82445, Taiwan; 5School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan; 6School of Medicine for International Student, I-Shou University, Kaohsiung, Taiwan; 7Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanCorrespondence: Yin-Chou Hsu, Department of Emergency Medicine, E-Da Hospital, No. 1, Yida Road, Jiao-Su Village, Yan-Chao District, Kaohsiung City, 82445, Taiwan, Tel [phone], Fax [phone], Email [email protected]: Klebsiella pneumoniae is an important causative pathogen of nosocomial infections, resulting in poor prognosis owing to its hypervirulence and antibiotic resistance. A simplified quicker version of the Pitt bacteremia score (PBS) (qPitt) for acute illness severity measurement was developed recently. The goal of this study was to explore the prognostic value of qPitt in patients with K. pneumoniae infection.Patients and Methods: Demographic information and management strategies were retrospectively collected from the records of all adult patients who visited the emergency department between January 1, 2021, and December 31, 2021, with culture-positive K. pneumoniae. The qPitt score was calculated based on: temperature < 36°C, systolic blood pressure ≤ 90 mmHg or vasopressor administration, respiratory rate ≥ 25 times/min or need of mechanical ventilation, altered mental status, and cardiac arrest event. The 30-day mortality prediction abilities of the qPitt were compared with the PBS, the sequential organ failure assessment (SOFA), and the quick sequential organ failure assessment (qSOFA) using receiver operating characteristic curves.Results: Data from 867 patients (57.8% men) with a mean age of 66.9 were compiled. The 30-day mortality rate of the enrolled patients was 13.4%, and the area under the curve (AUC) of the scoring systems were as follows: SOFA, 0.91 (95% confidence interval [CI]=0.89– 0.93), qPitt, 0.87 (95% CI=0.84– 0.89), PBS, 0.87 (95% CI=0.85– 0.89), and qSOFA, 0.73 (95% CI=0.70– 0.76). The AUC of qPitt was significantly higher than that of qSOFA (p< 0.01) and similar to that of PBS (p=0.65).The qPitt also demonstrated excellent mortality discrimination ability in non-bacteremic patients, AUC= 0.85 (95% CI=0.82– 0.88).Conclusion: The qPitt revealed excellent 30-day mortality prediction ability and also predicted mortality in non-bacteremic patients with K. pneumoniae infection. Clinicians can use this simplified scoring system to stratify patients earlier and initiate prompt treatment in high-risk patients.Keywords: Klebsiella pneumoniae, organ dysfunction scores, bacteremia, prognosis

Keywords

• klebsiella pneumoniae
• organ dysfunction scores
• bacteremia
• prognosis