Aube et al identified patients with bacteremia who are at high risk for septic shock. A patient at high risk for septic shock may benefit from more aggressive management. The authors are from Hopital General in Dijon, France.
Parameters:
(1) age and gender
(2) serum creatinine
(3) prothrombin time
(4) interstitial pattern on chest X-ray
|
Parameter |
Finding |
Points |
|
age and gender |
female |
0 |
|
|
male and <= 75 years |
0 |
|
|
male and > 75 years |
1 |
|
serum creatinine |
<= 2.0 mg/dL |
0 |
|
|
> 2.0 mg/dL |
1 |
|
prothrombin time |
>= 60% |
0 |
|
|
< 60% |
1 |
|
interstitial pattern on chest X-ray |
none |
0 |
|
|
<= 50% |
0 |
|
|
> 50% |
1 |
where:
• Reporting the prothrombin time in percent is done in Europe but not the US. The corresponding PT in seconds can be determined by diluting the sample with factor deficient plasma.
• Most of these findings reflect some type of organ dysfunction (interstitial pattern and CHF, decreased prothrombin time and coagulopathy).
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 4
• The risk of septic shock increases with the number of risk factors.
Performance:
• The positive predictive value was 55% and the negative predictive value was 89%. 77% of patients were accurately classified.
Other significant factors associated with septic shock:
(1) WBC count > 20,000 per µL
Findings associated with an increased risk of death:
(1) body temperature was < 38°C
(2) bacteremia with Pseudomonas aeruginosa or Streptococcus pneumoniae
Purpose: To identify a patient with bacteremia who is at high risk for septic shock based on the criteria of Aube et al.
Specialty: Infectious Diseases
Objective: risk factors
ICD-10: A49.9, R57.2,
