Development and validation of BLOOMY prediction scores for 14-day and 6-month mortality in hospitalised adults with bloodstream infections: a multicentre, prospective, cohort study.

BACKGROUND

The burden of bloodstream infections remains high worldwide and cannot be confined to short-term in-hospital mortality. We aimed to develop scores to predict short-term and long-term mortality in patients with bloodstream infections.

METHODS

The Bloodstream Infection due to Multidrug-resistant Organisms: Multicenter Study on Risk Factors and Clinical Outcomes (BLOOMY) study is a prospective, multicentre cohort study at six German tertiary care university hospitals to develop and validate two scores assessing 14-day and 6-month mortality in patients with bloodstream infections. We excluded patients younger than 18 years or who were admitted to an ophthalmology or psychiatry ward. Microbiological, clinical, laboratory, treatment, and survival data were prospectively collected on day 0 and day 3 and then from day 7 onwards, weekly. Participants were followed up for 6 months. All patients in the derivation cohort who were alive on day 3 were included in the analysis. Predictive scores were developed using logistic regression and Cox proportional hazards models with a machine-learning approach. Validation was completed using the C statistic and predictive accuracy was assessed using sensitivity, specificity, and predictive values.

FINDINGS

Between Feb 1, 2017, and Jan 31, 2019, 2568 (61·5%) of 4179 eligible patients were recruited into the derivation cohort. The in-hospital mortality rate was 23·75% (95% CI 22·15-25·44; 610 of 2568 patients) and the 6-month mortality rate was 41·55% (39·54-43·59; 949 of 2284). The model predictors for 14-day mortality (C statistic 0·873, 95% CI 0·849-0·896) and 6-month mortality (0·807, 0·784-0·831) included age, body-mass index, platelet and leukocyte counts, C-reactive protein concentrations, malignancy (ie, comorbidity), in-hospital acquisition, and pathogen. Additional predictors were, for 14-day mortality, mental status, hypotension, and the need for mechanical ventilation on day 3 and, for 6-month mortality, focus of infection, in-hospital complications, and glomerular filtration rate at the end of treatment. The scores were validated in a cohort of 1023 patients with bloodstream infections, recruited between Oct 9, 2019, and Dec 31, 2020. The BLOOMY 14-day score showed a sensitivity of 61·32% (95% CI 51·81-70·04), a specificity of 86·36% (83·80-88·58), a positive predictive value (PPV) of 37·57% (30·70-44·99), and a negative predictive value (NPV) of 94·35% (92·42-95·80). The BLOOMY 6-month score showed a sensitivity of 69·93% (61·97-76·84), a specificity of 66·44% (61·86-70·73), a PPV of 40·82% (34·85-47·07), and a NPV of 86·97% (82·91-90·18).

INTERPRETATION

The BLOOMY scores showed good discrimination and predictive values and could support the development of protocols to manage bloodstream infections and also help to estimate the short-term and long-term burdens of bloodstream infections.

FUNDING

DZIF German Center for Infection Research.

TRANSLATION

For the German translation of the abstract see Supplementary Materials section.

Informations de copyright

Copyright © 2022 Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests SP received grants or contracts from DZIF and the Gesundheitsforum Baden-Württemberg; consulting fees from IDbyDNA and Illumina; and speaker honoraria from bioMerieux Germany, all outside of this study. WVK received funding from the German Federal Ministry of Education and Research (BMBF) and travel support from the European Society of Clinical Microbiology and Infectious Diseases, all outside of this study. JF was supported during this study by a grant paid to DZIF from BMBF (grant number 8032808811). Study group member NTe was supported during this study by a grant paid to DZIF from BMBF (grant number 8032808811). FH received funding during this study as an employee of the University Hospital Tübingen and received support for travel and attending meetings related to this study from DZIF. HS received funding paid to his institution from DZIF for study personnel and consumables; personal consultancy fees from Debiopharm, Entasis, MSD, Shionogi, and ThermoFisher; fees or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Eumedica, Gilead, MSD, and Shionogi; and fees and support for attending meetings or travel from MSD, Gilead, and Shionogi. JR received funding for study personnel and support for attending regular study meetings from BMBF and DZIF. Study group member CI received grants or contracts paid to their institution by Shionogi and MSD; personal fees, consultancy fees, and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Shionogi and MSD; received consumables, study drugs, editorial assistance for manuscript development (outside of this study) from Eumedica; and was on an advisory board for MSD and Shionogi. JJV received grants from MSD, Gilead, Pfizer, Astellas Pharma, Basilea, DZIF, BMBF, German Aerospace Centre (DLR), University of Bristol, and Rigshospitalet Copenhagen; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from MSD, Gilead, Pfizer, Astellas Pharma, Basilea, DZIF, University Hospital Freiburg, Congress and Communication, Academy for Infectious Medicine, University of Manchester, German Society for Infectious Diseases, Ärztekammer Nordrhein, University Hospital Aachen, Back Bay Strategies, German Society for Internal Medicine, Shionogi, Molecular Health, Netzwerk Universitätsmedizin, Janssen, and NordForsk; and consulting fees from Pfizer, Gilead, and Shionogi. MJGTV received consulting fees from MSD, SocraTec R&D, Farmak International Holding, and Gilead Sciences; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from MSD, Ferring, Roche, and Pfizer; and grants or contracts from BioNTtech, Immunic Therapeutics, MSD, Seres Therapeutics, Takeda Pharmaceutical, Heel, and Roche. All other authors ans DZIF BLOOMY study group members declare no competing interests.