Sho Sasaki1,2,3, Yoshihiko Raita4,5, Minoru Murakami6, Shungo Yamamoto3,7, Kentaro Tochitani3,7, Takeshi Hasegawa8,9,10, Kiichiro Fujisaki1, Shunichi Fukuhara10,11,12. 1. Department of Nephrology, Iizuka Hospital, Fukuoka, Japan. 2. Clinical Research Support Office, Iizuka Hospital, Fukuoka, Japan. 3. Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan. 4. Department of Nephrology, Okinawa Prefectural Chubu Hospital, Naha, Japan. 5. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America. 6. Department of Nephrology, Saku Central Hospital, Nagano, Japan. 7. Department of Infectious Disease, Kyoto City Hospital, Kyoto, Japan. 8. Office for Promoting Medical Research, Showa University, Tokyo, Japan. 9. Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan. 10. Fukushima Medical University, Fukushima, Japan. 11. Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan. 12. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
Abstract
INTRODUCTION: Having developed a clinical prediction rule (CPR) for bacteremia among hemodialysis (HD) outpatients (BAC-HD score), we performed external validation. MATERIALS & METHODS: Data were collected on maintenance HD patients at two Japanese tertiary-care hospitals from January 2013 to December 2015. We enrolled 429 consecutive patients (aged ≥ 18 y) on maintenance HD who had had two sets of blood cultures drawn on admission to assess for bacteremia. We validated the predictive ability of the CPR using two validation cohorts. Index tests were the BAC-HD score and a CPR developed by Shapiro et al. The outcome was bacteremia, based on the results of the admission blood cultures. For added value, we also measured changes in the area under the receiver operating characteristic curve (AUC) using logistic regression and Net Reclassification Improvement (NRI), in which each CPR was added to the basic model. RESULTS: In Validation cohort 1 (360 subjects), compared to a Model 1 (Basic Model) AUC of 0.69 (95% confidence interval [95% CI]: 0.59-0.80), the AUC of Model 2 (Basic model + BAC-HD score) and Model 3 (Basic model + Shapiro's score) increased to 0.8 (95% CI: 0.71-0.88) and 0.73 (95% CI: 0.63-0.83), respectively. In validation cohort 2 (96 subjects), compared to a Model 1 AUC of 0.81 (95% CI: 0.68-0.94), the AUCs of Model 2 and Model 3 increased to 0.83 (95% CI: 0.72-0.95) and 0.85 (95% CI: 0.76-0.94), respectively. NRIs on addition of the BAC-HD score and Shapiro's score were 0.3 and 0.06 in Validation cohort 1, and 0.27 and 0.13, respectively, in Validation cohort 2. CONCLUSION: Either the BAC-HD score or Shapiro's score may improve the ability to diagnose bacteremia in HD patients. Reclassification was better with the BAC-HD score.
INTRODUCTION: Having developed a clinical prediction rule (CPR) for bacteremia among hemodialysis (HD) outpatients (BAC-HD score), we performed external validation. MATERIALS & METHODS: Data were collected on maintenance HDpatients at two Japanese tertiary-care hospitals from January 2013 to December 2015. We enrolled 429 consecutive patients (aged ≥ 18 y) on maintenance HD who had had two sets of blood cultures drawn on admission to assess for bacteremia. We validated the predictive ability of the CPR using two validation cohorts. Index tests were the BAC-HD score and a CPR developed by Shapiro et al. The outcome was bacteremia, based on the results of the admission blood cultures. For added value, we also measured changes in the area under the receiver operating characteristic curve (AUC) using logistic regression and Net Reclassification Improvement (NRI), in which each CPR was added to the basic model. RESULTS: In Validation cohort 1 (360 subjects), compared to a Model 1 (Basic Model) AUC of 0.69 (95% confidence interval [95% CI]: 0.59-0.80), the AUC of Model 2 (Basic model + BAC-HD score) and Model 3 (Basic model + Shapiro's score) increased to 0.8 (95% CI: 0.71-0.88) and 0.73 (95% CI: 0.63-0.83), respectively. In validation cohort 2 (96 subjects), compared to a Model 1 AUC of 0.81 (95% CI: 0.68-0.94), the AUCs of Model 2 and Model 3 increased to 0.83 (95% CI: 0.72-0.95) and 0.85 (95% CI: 0.76-0.94), respectively. NRIs on addition of the BAC-HD score and Shapiro's score were 0.3 and 0.06 in Validation cohort 1, and 0.27 and 0.13, respectively, in Validation cohort 2. CONCLUSION: Either the BAC-HD score or Shapiro's score may improve the ability to diagnose bacteremia in HDpatients. Reclassification was better with the BAC-HD score.
Authors: Marie K Jessen; Julie Mackenhauer; Anne Mette S W Hvass; Svend Ellermann-Eriksen; Simon Skibsted; Hans Kirkegaard; Henrik C Schønheyder; Nathan I Shapiro Journal: Eur J Emerg Med Date: 2016-02 Impact factor: 2.799
Authors: Ricard Ferrer; Ignacio Martin-Loeches; Gary Phillips; Tiffany M Osborn; Sean Townsend; R Phillip Dellinger; Antonio Artigas; Christa Schorr; Mitchell M Levy Journal: Crit Care Med Date: 2014-08 Impact factor: 7.598
Authors: Lise H Nielsen; Søren Jensen-Fangel; Thomas Benfield; Robert Skov; Bente Jespersen; Anders R Larsen; Lars Østergaard; Henrik Støvring; Henrik C Schønheyder; Ole S Søgaard Journal: BMC Infect Dis Date: 2015-01-08 Impact factor: 3.090