PREDICTORS OF MORTALITY IN PATIENTS WITH BACTEREMIA - THE IMPORTANCE OF FUNCTIONAL STATUS

OBJECTIVE: To evaluate the influence of functional status on the outco me in older patients with bacteremia. DESIGN: Prospective study of all episodes of bacteremia that occurred in adults during a 27-month peri od (January 1991 to March 1993). SETTING: A 280-bed community hospital . PARTICIPANTS: During the study period, bacteremia was diagnosed in 2 42 consecutive patients (incidence of 11.2 bacteremic episodes per 100 0 hospital admissions). One hundred twenty-seven of these patients wer e 65 years of age or older, and 115 were less than age 65. MEASUREMENT S: On identification of a positive blood culture, data on demographics , clinical findings, and a series of factors frequently cited as predi sposing to infection were collected. The patient's functional status w as assessed using the Barthel index (a score of <60 identities moderat ely and highly dependent patients). RESULTS: The overall mortality rat e was 14.9% (36 of 242). In the univariate analysis, mortality was ass ociated significantly with age greater than 65 years, nosocomial infec tion, absence of fever, shock, leukocytosis or leukopenia, inappropria te therapy, more than one underlying disease, immunocompromised state, and limited functional status. Multiple logistic regression analysis revealed that shock (OR = 27.6, 95% CI 5.7 - 133), a Barthel score les s than 60 (OR = 11.7, 95% CI 3.2 - 43), nosocomial infection (OR = 6.7 , 95% CI 1.8 - 25.5), absence of fever (OR = 5.2, 95% CI 1.05 - 26), a nd immunocompromised state (OR = 15.6, 95% CI 2.4 - 101.5) were signif icantly associated with death attributable to bacteremia. CONCLUSION: The main prognostic factors in a patient with bacteremia were the pres ence of shock, impaired functional status, immunodeficiency state, acq uisition of infection in the hospital, and absence of fever on admissi on. Age alone did not influence outcome.