Bacteremia Prediction Model for Community-acquired Pneumonia

External Validation in a Multicenter Retrospective Cohort

Byunghyun Kim, Jungho Choi, Kyuseok Kim, Sujin Jang, Tae Gun Shin, Won Young Kim, Jung Youn Kim, Yoo Seok Park, Soo Hyun Kim, Hui Jai Lee, Jong Hwan Shin, Je Sung You, Kyung Su Kim, Sung Phil Chung

Research output: Contribution to journalReview articleResearchpeer-review

4 Citations (Scopus)

Abstract

Objective: Many studies have described constructing a prediction model for bacteremia in community-acquired pneumonia (CAP), but these studies were not validated in external heterogeneous groups. The objective of this study was to test the generalizability of a previous bacteremia prediction model for CAP by external validation. Methods: This multicenter retrospective cohort analysis was performed in eight tertiary urban hospital emergency departments (EDs). We reviewed adult patients who were hospitalized after presentation to the ED with CAP. We categorized the enrolled patients into three groups according to the bacteremia prediction model score and calculated the number of patients with or without a blood culture–positive result. We performed a multivariable analysis to identify significant predictors for bacteremia. Results: Among the enrolled 2,001 patients, 1,592 (79.6%), 371 (18.5%), and 38 (1.9%) were stratified to a low-, moderate-, and high-risk group, respectively, and this proportion was similar with previous study. Each group had a bacteremia-positive rate as follows: 1.2% for the low-risk group, 7.2% for the moderate-risk group, and 31.5% for the high-risk group. The area under the receiver operating characteristic curve for the bacteremia model in the external validation cohort was 0.81, and there was no significant difference with that of the previous internal validation cohort (p = 0.246). Assuming that blood cultures were not performed in the low-risk patients, the sensitivity and specificity of this model were 0.68 and 0.81, respectively. Additionally, the positive predictive value and negative predictive value were 9.54 and 98.87%, respectively. A platelet count less than 130 × 10 9 cells/L, albumin less than 3.3 mg/dL, and C-reactive protein greater than 17 mg/dL were identified as significant predictors with a sensitivity and specificity of 0.70 and 0.83, respectively. Conclusion: The bacteremia prediction model was well validated in the general population and could help physicians make the decision to reduce the number of blood cultures in patients with CAP.

Original languageEnglish
Pages (from-to)1226-1234
Number of pages9
JournalAcademic Emergency Medicine
Volume24
Issue number10
DOIs
StatePublished - 1 Oct 2017

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Bacteremia
Pneumonia
Hospital Emergency Service
Sensitivity and Specificity
Urban Hospitals
Hospital Departments
Platelet Count
Tertiary Care Centers
ROC Curve
C-Reactive Protein
Albumins
Cohort Studies
Physicians
Population

Cite this

Kim, Byunghyun ; Choi, Jungho ; Kim, Kyuseok ; Jang, Sujin ; Shin, Tae Gun ; Kim, Won Young ; Kim, Jung Youn ; Park, Yoo Seok ; Kim, Soo Hyun ; Lee, Hui Jai ; Shin, Jong Hwan ; You, Je Sung ; Kim, Kyung Su ; Chung, Sung Phil. / Bacteremia Prediction Model for Community-acquired Pneumonia : External Validation in a Multicenter Retrospective Cohort. In: Academic Emergency Medicine. 2017 ; Vol. 24, No. 10. pp. 1226-1234.
@article{9a3230af5a3e44928533e60e337c6500,
title = "Bacteremia Prediction Model for Community-acquired Pneumonia: External Validation in a Multicenter Retrospective Cohort",
abstract = "Objective: Many studies have described constructing a prediction model for bacteremia in community-acquired pneumonia (CAP), but these studies were not validated in external heterogeneous groups. The objective of this study was to test the generalizability of a previous bacteremia prediction model for CAP by external validation. Methods: This multicenter retrospective cohort analysis was performed in eight tertiary urban hospital emergency departments (EDs). We reviewed adult patients who were hospitalized after presentation to the ED with CAP. We categorized the enrolled patients into three groups according to the bacteremia prediction model score and calculated the number of patients with or without a blood culture–positive result. We performed a multivariable analysis to identify significant predictors for bacteremia. Results: Among the enrolled 2,001 patients, 1,592 (79.6{\%}), 371 (18.5{\%}), and 38 (1.9{\%}) were stratified to a low-, moderate-, and high-risk group, respectively, and this proportion was similar with previous study. Each group had a bacteremia-positive rate as follows: 1.2{\%} for the low-risk group, 7.2{\%} for the moderate-risk group, and 31.5{\%} for the high-risk group. The area under the receiver operating characteristic curve for the bacteremia model in the external validation cohort was 0.81, and there was no significant difference with that of the previous internal validation cohort (p = 0.246). Assuming that blood cultures were not performed in the low-risk patients, the sensitivity and specificity of this model were 0.68 and 0.81, respectively. Additionally, the positive predictive value and negative predictive value were 9.54 and 98.87{\%}, respectively. A platelet count less than 130 × 10 9 cells/L, albumin less than 3.3 mg/dL, and C-reactive protein greater than 17 mg/dL were identified as significant predictors with a sensitivity and specificity of 0.70 and 0.83, respectively. Conclusion: The bacteremia prediction model was well validated in the general population and could help physicians make the decision to reduce the number of blood cultures in patients with CAP.",
author = "Byunghyun Kim and Jungho Choi and Kyuseok Kim and Sujin Jang and Shin, {Tae Gun} and Kim, {Won Young} and Kim, {Jung Youn} and Park, {Yoo Seok} and Kim, {Soo Hyun} and Lee, {Hui Jai} and Shin, {Jong Hwan} and You, {Je Sung} and Kim, {Kyung Su} and Chung, {Sung Phil}",
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doi = "10.1111/acem.13255",
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Bacteremia Prediction Model for Community-acquired Pneumonia : External Validation in a Multicenter Retrospective Cohort. / Kim, Byunghyun; Choi, Jungho; Kim, Kyuseok; Jang, Sujin; Shin, Tae Gun; Kim, Won Young; Kim, Jung Youn; Park, Yoo Seok; Kim, Soo Hyun; Lee, Hui Jai; Shin, Jong Hwan; You, Je Sung; Kim, Kyung Su; Chung, Sung Phil.

In: Academic Emergency Medicine, Vol. 24, No. 10, 01.10.2017, p. 1226-1234.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Bacteremia Prediction Model for Community-acquired Pneumonia

T2 - External Validation in a Multicenter Retrospective Cohort

AU - Kim, Byunghyun

AU - Choi, Jungho

AU - Kim, Kyuseok

AU - Jang, Sujin

AU - Shin, Tae Gun

AU - Kim, Won Young

AU - Kim, Jung Youn

AU - Park, Yoo Seok

AU - Kim, Soo Hyun

AU - Lee, Hui Jai

AU - Shin, Jong Hwan

AU - You, Je Sung

AU - Kim, Kyung Su

AU - Chung, Sung Phil

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Objective: Many studies have described constructing a prediction model for bacteremia in community-acquired pneumonia (CAP), but these studies were not validated in external heterogeneous groups. The objective of this study was to test the generalizability of a previous bacteremia prediction model for CAP by external validation. Methods: This multicenter retrospective cohort analysis was performed in eight tertiary urban hospital emergency departments (EDs). We reviewed adult patients who were hospitalized after presentation to the ED with CAP. We categorized the enrolled patients into three groups according to the bacteremia prediction model score and calculated the number of patients with or without a blood culture–positive result. We performed a multivariable analysis to identify significant predictors for bacteremia. Results: Among the enrolled 2,001 patients, 1,592 (79.6%), 371 (18.5%), and 38 (1.9%) were stratified to a low-, moderate-, and high-risk group, respectively, and this proportion was similar with previous study. Each group had a bacteremia-positive rate as follows: 1.2% for the low-risk group, 7.2% for the moderate-risk group, and 31.5% for the high-risk group. The area under the receiver operating characteristic curve for the bacteremia model in the external validation cohort was 0.81, and there was no significant difference with that of the previous internal validation cohort (p = 0.246). Assuming that blood cultures were not performed in the low-risk patients, the sensitivity and specificity of this model were 0.68 and 0.81, respectively. Additionally, the positive predictive value and negative predictive value were 9.54 and 98.87%, respectively. A platelet count less than 130 × 10 9 cells/L, albumin less than 3.3 mg/dL, and C-reactive protein greater than 17 mg/dL were identified as significant predictors with a sensitivity and specificity of 0.70 and 0.83, respectively. Conclusion: The bacteremia prediction model was well validated in the general population and could help physicians make the decision to reduce the number of blood cultures in patients with CAP.

AB - Objective: Many studies have described constructing a prediction model for bacteremia in community-acquired pneumonia (CAP), but these studies were not validated in external heterogeneous groups. The objective of this study was to test the generalizability of a previous bacteremia prediction model for CAP by external validation. Methods: This multicenter retrospective cohort analysis was performed in eight tertiary urban hospital emergency departments (EDs). We reviewed adult patients who were hospitalized after presentation to the ED with CAP. We categorized the enrolled patients into three groups according to the bacteremia prediction model score and calculated the number of patients with or without a blood culture–positive result. We performed a multivariable analysis to identify significant predictors for bacteremia. Results: Among the enrolled 2,001 patients, 1,592 (79.6%), 371 (18.5%), and 38 (1.9%) were stratified to a low-, moderate-, and high-risk group, respectively, and this proportion was similar with previous study. Each group had a bacteremia-positive rate as follows: 1.2% for the low-risk group, 7.2% for the moderate-risk group, and 31.5% for the high-risk group. The area under the receiver operating characteristic curve for the bacteremia model in the external validation cohort was 0.81, and there was no significant difference with that of the previous internal validation cohort (p = 0.246). Assuming that blood cultures were not performed in the low-risk patients, the sensitivity and specificity of this model were 0.68 and 0.81, respectively. Additionally, the positive predictive value and negative predictive value were 9.54 and 98.87%, respectively. A platelet count less than 130 × 10 9 cells/L, albumin less than 3.3 mg/dL, and C-reactive protein greater than 17 mg/dL were identified as significant predictors with a sensitivity and specificity of 0.70 and 0.83, respectively. Conclusion: The bacteremia prediction model was well validated in the general population and could help physicians make the decision to reduce the number of blood cultures in patients with CAP.

UR - http://www.scopus.com/inward/record.url?scp=85030626938&partnerID=8YFLogxK

U2 - 10.1111/acem.13255

DO - 10.1111/acem.13255

M3 - Review article

VL - 24

SP - 1226

EP - 1234

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 10

ER -