A simple score to predict early death in adult cancer patients with bloodstream infections Eduardo Velasco a, *, Rodrigo D. Portugal b , Jorge I.F. Salluh c a Rua General Glice´rio 486/1002; Laranjeiras; Cep 22245-120; Rio de Janeiro, Brazil b Service of Hematology, Federal University of Rio de Janeiro, Brazil c Intensive Care Unit, Hospital do Caˆncer, National Cancer Institute, Rio de Janeiro, Salluh Accepted 19 August 2009 Available online 23 August 2009 KEYWORDS Predictive score model; Mortality; Adult cancer patients; Bloodstream infections Summary Objective: To develop a simple score to predict early death in adult cancer patients with bloodstream infection. Methods: A prediction score was developed by analyzing data collected from 361 episodes of BSI at an oncology cancer care center in Brazil. Early death was defined as all deaths occurring within 7 days of the first positive blood culture. Results: Multivariate regression analysis identified poor Karnofsky performance status, uncon- trolled cancer, hypotension, pulmonary infiltrates, associated infectious sites, and neutrope- nia as independently associated with death. Predictive scores were developed assigning points to each significant independent variable. The overall mortality was 20.5% and, the total weighted score ranged from 0 to 11 points, with a very good calibration (HosmereLemeshow statistic, P Z 0.92) and discrimination (area under receiver operating characteristic curve Z 0.893). The cutoff value for the predictive score was 3 points, with a negative predic- tive value of 99% and sensitivity of 98.6%. Conclusion: The score model was able to identify adult cancer patients with bloodstream in- fection at lower risk for early death with an elevated degree of certainty as depicted by a very high negative predictive value. It is essential to prospectively validate the rule in a different group of patients. ª 2009 The British Infection Society. Published by Elsevier Ltd. All rights reserved. Introduction Bloodstream infections (BSIs) are among the most serious problems faced by cancer patients treated by aggressive immunosuppressive therapy with profound impact on the clinical course and the outcome. 1 Several studies involving febrile neutropenic cancer patients have attempted to identify subsets of patients according to their risk for the development of medical complications. 2e5 Among severe complications, BSI is one of the most common health care-associated infections and concurrent serious illness conditions very often impose a poor outcome. 6e8 * Corresponding author. E-mail address: evelasco@inca.gov.b (E. Velasco). 0163-4453/$36 ª 2009 The British Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jinf.2009.08.009 www.elsevierhealth.com/journals/jinf Journal of Infection (2009) 59, 332e336