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. 2025 Jul 23.
doi: 10.1007/s15010-025-02614-9. Online ahead of print.

Development and validation of a predictive mortality scoring model for bloodstream infections due to Escherichia coli in the PROBAC cohort

Paula Olivares-Navarro  1   2 , María Teresa Pérez-Rodríguez  3 , Ane Josune Goikoetxea-Agirre  4 , José María Reguera-Iglesias  5 , Eva León  6 , María Ángeles Mantecón  7 , Ángeles Pulido-Navazo  8 , Lucía Boix-Palop  9 , Pilar Retamar-Gentil  1   2 , Carlos Armiñanzas-Castillo  2   10 , Isabel Fernández-Natal  11 , Alfredo Jover-Sáenz  12 , Alfonso Del Arco Jiménez  13 , Jonathan Fernández-Suárez  14 , Andrés Martín-Aspas  15 , Alejandro Smithson-Amat  16 , Alberto Bahamonde Carrasco  17 , Clara Natera-Kindelán  18 , Pedro Martínez Pérez-Crespo  6 , Inmaculada López Hernández  1   2 , Luis Eduardo López-Cortés  19   20   21 , Jesús Rodríguez-Baño  1   2 ; PROBAC/GEIRAS-SEIMC/SAMICEI
Collaborators, Affiliations

Development and validation of a predictive mortality scoring model for bloodstream infections due to Escherichia coli in the PROBAC cohort

Paula Olivares-Navarro et al. Infection. .

Abstract

Introduction: Escherichia coli is the most frequent cause of bacteraemia and has a major impact on morbidity and mortality. The aim of this study is to define and internally validate a predictive risk score of 30-day all-cause mortality.

Methods: A prospective, multicentre, cohort study conducted in 26 Spanish hospitals between October 2016 and March 2017 was performed. All monomicrobial E. coli bloodstream infections (BSIs) were included. The primary outcome was 30-day all-cause mortality. Cases were randomized to a derivation cohort (DC) and a validation cohort (VC). The predictive score was calculated from a multivariable model performed by logistic regression in the DC and subsequently applied to the VC. The predictive ability of the model was estimated by calculating the area under the ROC curve (AUROC) and the goodness of fit by Hosmer-Lemeshow test and calibration plot.

Results: Overall, 1435 cases were included in the DC and 715 in the VC. The final multivariable model for mortality in DC included (adjusted OR; 95% CI) age over 55 years (2.10; 1.01-4.36), dementia (2.08; 1.24-3.50), liver disease (1.81; 0.99-3.28), healthcare-associated acquisition (2.29; 1.52-3.44), Pitt index > 3 (3.59; 2.30-5.61), SOFA ≥ 2 (1.66; 1.04-2.64), and urinary tract source (0.37; 0.24-0.56). The predictive score showed an AUROC of 0.78 (95% CI 0.74-0.83) in the DC and 0.78 (95% CI 0.73-0.84) in the VC.

Conclusion: We developed and internally validated a predictive scoring model to identify patients with E. coli bacteraemia at high and low risk of crude mortality on day 30 of BSI.

Keywords: Escherichia coli; Bloodstream infection; Mortality; Predictive model.

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Conflict of interest statement

Declarations. Competing Interests: The authors declare no competing interests. Ethics approval: This study was conducted according with the Declaration of Helsinki and national and institutional standards. PROBAC study was approved by the Spanish Medicines Agency and the Ethics Committee of the Hospital Universitario Virgen Macarena with waiver for informed consent due to the observational design (approval reference code: FIS-AMO-201601). Approval was also obtained at each participating centre.

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