Pathophysiological responses to bloodstream infection in critically ill transplant recipients compared to non-transplant recipients.
bloodstream infection
critical care
inflammation
sepsis
transplant
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
27 Oct 2023
27 Oct 2023
Historique:
received:
26
07
2023
revised:
12
10
2023
accepted:
25
10
2023
medline:
27
10
2023
pubmed:
27
10
2023
entrez:
27
10
2023
Statut:
aheadofprint
Résumé
Identification of bloodstream infection (BSI) in transplant recipients may be difficult due to immunosuppression. Accordingly, we aimed to compare responses to BSI in critically ill transplant and non-transplant recipients and to modify systemic inflammatory response syndrome (SIRS) criteria for transplant recipients. We analyzed univariate risks and developed multivariable models of BSI with 27 clinical variables from adult intensive care unit (ICU) patients at the University of Virginia (UVA) and at the University of Pittsburgh (Pitt). We used Bayesian inference to adjust SIRS criteria for transplant recipients. We analyzed 38.7 million hourly measurements from 41,725 patients at UVA, including 1,897 transplant recipients with 193 episodes of BSI, and 53,608 patients at Pitt, including 1,614 transplant recipients with 768 episodes of BSI. The univariate responses to BSI were comparable in transplant and non-transplant recipients. The area under the receiver operating characteristic curve (AUC) was 0.82 (95% confidence interval [CI], 0.80-0.83) for the model using all UVA patient data and 0.80 (95% CI, 0.76-0.83) when using only transplant recipient data. The UVA all-patient model had an AUC of 0.77 (95%CI, 0.76-0.79) in non-transplant recipients and 0.75 (95% CI, 0.71-0.79) in transplant recipients at Pitt. The relative importance of the 27 predictors was similar in transplant and non-transplant models. An upper temperature of 37.5°C in SIRS criteria improved reclassification performance in transplant recipients. Critically ill transplant and non-transplant recipients had similar responses to BSI. An upper temperature of 37.5°C in SIRS criteria improved BSI screening in transplant recipients.
Sections du résumé
BACKGROUND
BACKGROUND
Identification of bloodstream infection (BSI) in transplant recipients may be difficult due to immunosuppression. Accordingly, we aimed to compare responses to BSI in critically ill transplant and non-transplant recipients and to modify systemic inflammatory response syndrome (SIRS) criteria for transplant recipients.
METHODS
METHODS
We analyzed univariate risks and developed multivariable models of BSI with 27 clinical variables from adult intensive care unit (ICU) patients at the University of Virginia (UVA) and at the University of Pittsburgh (Pitt). We used Bayesian inference to adjust SIRS criteria for transplant recipients.
RESULTS
RESULTS
We analyzed 38.7 million hourly measurements from 41,725 patients at UVA, including 1,897 transplant recipients with 193 episodes of BSI, and 53,608 patients at Pitt, including 1,614 transplant recipients with 768 episodes of BSI. The univariate responses to BSI were comparable in transplant and non-transplant recipients. The area under the receiver operating characteristic curve (AUC) was 0.82 (95% confidence interval [CI], 0.80-0.83) for the model using all UVA patient data and 0.80 (95% CI, 0.76-0.83) when using only transplant recipient data. The UVA all-patient model had an AUC of 0.77 (95%CI, 0.76-0.79) in non-transplant recipients and 0.75 (95% CI, 0.71-0.79) in transplant recipients at Pitt. The relative importance of the 27 predictors was similar in transplant and non-transplant models. An upper temperature of 37.5°C in SIRS criteria improved reclassification performance in transplant recipients.
CONCLUSION
CONCLUSIONS
Critically ill transplant and non-transplant recipients had similar responses to BSI. An upper temperature of 37.5°C in SIRS criteria improved BSI screening in transplant recipients.
Identifiants
pubmed: 37889515
pii: 7331104
doi: 10.1093/cid/ciad662
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.