Better Performance of Modified Scoring Systems to Predict the Clinical Outcomes of Vibrio Bacteremia in the Emergency Department: An Observational Study

Abstract

Background: Vibrio is a genus of Gram-negative bacteria found in various aquatic environments, including saltwater and freshwater. Vibrio bacteremia can lead to sepsis, a potentially life-threatening condition in which the immune system enters overdrive in response to the disease, causing widespread inflammation and damage to tissues and organs. V. vulnificus had the highest case fatality rate (39%) of all reported foodborne infections in the United States and a high mortality rate in Asia, including Taiwan. Numerous scoring systems have been created to estimate the mortality risk in the emergency department (ED). However, there are no specific scoring systems to predict the mortality risk of Vibrio bacteremia. Therefore, this study modified the existing scoring systems to better predict the mortality risk of Vibrio bacteremia.

Methods: Cases of Vibrio bacteremia were diagnosed based on the results from at least one blood culture in the ED. Patient data were extracted from the electronic clinical database, covering January 2012 to December 2021. The primary outcome was in-hospital mortality.This study used univariate and multivariate analyses to evaluate the mortality risk.

Results: This study enrolled 36 patients diagnosed with Vibrio bacteremia, including 23 males (63.9%) and 13 females (36.1%), with a mean age of 65.1 ± 15.7 years. The in-hospital mortality rate amounted to 25% (9/36), with 31.5% in V. vulnificus (6/19) and 17.6% in V. non-vulnificus (3/17). The non-survivors demonstrated higher MEDS (10.3 ± 2.4) than the survivors (6.2 ± 4.1) (p = 0.002). Concerning the qSOFA, the survivors scored 0.3 ± 0.5, and the non-survivors displayed a score of 0.6 ± 0.7 (p = 0.387). The AUC of the ROC for the MEDS and qSOFA was 0.833 and 0.599, respectively. This study modified the scoring systems with other predictive factors, including BUN and pH. The AUC of the ROC for the modified MEDS and qSOFA reached up to 0.852 and 0.802, respectively.

Conclusion: The MEDS could serve as reliable indicators for forecasting the mortality rate of patients grappling with Vibrio bacteremia. This study modified the MEDS and qSOFA to strengthen the predictive performance of mortality risk for Vibrio bacteremia. We advocate the prompt initiation of targeted therapeutic interventions and judicious antibiotic treatments to curb fatality rates.

Keywords: Vibrio; bacteremia; mortality risk; scoring systems; seasonal distribution.

Figure 1

The trend association between the mortality cases of Vibrio bacteremia and seasonal distribution (p = 0.044).

Figure 2

The AUC of ROC of the MEDS, WPS, qSOFA, and REMS in predicting the mortality risks of patients with Vibrio bacteremia (Panel A). The AUC of ROC of the modified MEDS, WPS, qSOFA, and REMS in predicting the mortality risks of patients with Vibrio bacteremia (Panel B). AUC = area under the curve; ROC = receiver operating characteristic curve.

Figure 3

The cumulative 30-day survival rates of patients with Vibrio bacteremia were calculated by Kaplan–Meier. The cut-off points of the original MEDS, WPS, qSOFA, and REMS were 10, 5, 1, and 6. Abbreviations: MEDS, Mortality in Emergency Department Sepsis; REMS, Rapid Emergency Medicine Score; qSOFA, quick Sepsis-related Organ Failure Assessment; WPS, Worthing Physiological Scoring system.

Figure 4

The cumulative 30-day survival rates of patients with Vibrio bacteremia were calculated by Kaplan–Meier. The cut-off points of the modified MEDS, WPS, qSOFA, and REMS were 10, 5, 1, and 6. Abbreviations: MEDS, Mortality in Emergency Department Sepsis; REMS, Rapid Emergency Medicine Score; qSOFA, quick Sepsis-related Organ Failure Assessment; WPS, Worthing Physiological Scoring system.

Figure 5

Discrimination plots showing the mortality rates of 71.4%, 75.0%, 50.0%, and 30.0% in the original scoring systems of the MEDS, WPS, qSOFA, and REMS if the cut-off points were more than 10, 5, 1, and 6, respectively. Abbreviations: MEDS, Mortality in Emergency Department Sepsis; REMS, Rapid Emergency Medicine Score; qSOFA, quick Sepsis-related Organ Failure Assessment; WPS, Worthing Physiological Scoring system.

Figure 6

Discrimination plots showing the mortality rates of 75.0%, 66.7%, 55.6%, and 33.3% in the scoring systems of the modified MEDS, WPS, qSOFA, and REMS if the cut-off points were more than 10, 5, 1, and 6, respectively. Abbreviations: MEDS, Mortality in Emergency Department Sepsis; REMS, Rapid Emergency Medicine Score; qSOFA, quick Sepsis-related Organ Failure Assessment; WPS, Worthing Physiological Scoring system.