Bloodstream infection: Derivation and validation of a reliable and multidimensional prognostic score based on a machine learning model (BLISCO).

Abstract

Background: A bloodstream infection (BSI) prognostic score applicable at the time of blood culture collection is missing.

Methods: In total, 4,327 patients with BSIs were included, divided into a derivation (80%) and a validation dataset (20%). Forty-two variables among host-related, demographic, epidemiological, clinical, and laboratory extracted from the electronic health records were analyzed. Logistic regression was chosen for predictive scoring.

Results: The 14-day mortality model included age, body temperature, blood urea nitrogen, respiratory insufficiency, platelet count, high-sensitive C-reactive protein, and consciousness status: a score of ≥ 6 was correlated to a 14-day mortality rate of 15% with a sensitivity of 0.742, a specificity of 0.727, and an area under the curve of 0.783. The 30-day mortality model further included cardiovascular diseases: a score of ≥ 6 predicting 30-day mortality rate of 15% with a sensitivity of 0.691, a specificity of 0.699, and an area under the curve of 0.697.

Conclusions: A quick mortality score could represent a valid support for prognosis assessment and resources prioritizing for patients with BSIs not admitted in the intensive care unit.