TY - JOUR
T1 - Validation of the INCREMENT-SOT-CPE score in a large cohort of liver transplant recipients with carbapenem-resistant Enterobacterales infection
AU - CRECOOLT study group
AU - Rinaldi, Matteo
AU - Bonazzetti, Cecilia
AU - Gallo, Mena
AU - Ferraro, Giuseppe
AU - Freire, Maristela
AU - Terrabuio, Débora Raquel Benedita
AU - Tandoi, Francesco
AU - Romagnoli, Renato
AU - De Rosa, Francesco Giuseppe
AU - Mularoni, Alessandra
AU - Ferrarese, Alberto
AU - Burra, Patrizia
AU - Halpern, Marcia
AU - Balbi, Elizabeth
AU - Simkins, Jacques
AU - Abbo, Lilian
AU - Morrás, Ignacio
AU - Cantero, Mireia
AU - Alagna, Laura
AU - Bandera, Alessandra
AU - Clemente, Wanessa Trinidade
AU - Valerio, Maricela
AU - Fernández, Ainhoa
AU - Muñoz, Patricia
AU - Statlender, Liran
AU - Yahav, Dafna
AU - Camargo, Luis Fernando Aranha
AU - Girão, Evelyne Santana
AU - Grossi, Paolo
AU - Viale, Pierluigi
AU - Curti, Stefania
AU - Giannella, Maddalena
N1 - Publisher Copyright:
© 2023 The Authors. Transplant Infectious Disease published by Wiley Periodicals LLC.
PY - 2023/4
Y1 - 2023/4
N2 - Background: Management of infections due to carbapenemase-resistant Enterobacterales (CRE) in solid organ transplant (SOT) recipients remains a difficult challenge. The INCREMENT-SOT-CPE score has been specifically developed from SOT recipients to stratify mortality risk, but an external validation is lacking. Methods: Multicenter retrospective cohort study of liver transplant (LT) recipients colonized with CRE infection who developed infection after transplant over 7-year period. Primary endpoint was all-cause 30-day mortality from infection onset. A comparison between INCREMENT-SOT-CPE and other selected scores was performed. A two-level mixed effects logistic regression model with random effects for the center was fitted. Performance characteristics at optimal cut-point were calculated. Multivariable Cox regression analysis of risk factors for all-cause 30-day mortality was carried out. Results: Overall, 250 CRE carriers developed infection after LT and were analyzed. The median age was 55 years (interquartile range [IQR]: 46–62) and 157 were males (62.8%). All-cause 30-day mortality was 35.6%. A sequential organ failure assessment (SOFA) score ≥ 11 showed a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 69.7%, 76.4%, 62.0%, 82.0%, and 74.0%, respectively. An INCREMENT-SOT-CPE ≥ 11 reported a sensitivity, specificity, PPV, NPV, and accuracy of 73.0%, 62.1%, 51.6%, 80.6% and 66.0%, respectively. At multivariable analysis acute renal failure, prolonged mechanical ventilation, INCREMENT-SOT-CPE score ≥ 11 and SOFA score ≥ 11 were independently associated with all-cause 30-day mortality, while a tigecycline-based targeted regimen was found to be protective. Conclusions: Both INCREMENT-SOT-CPE ≥ 11 and SOFA ≥ 11 were identified as strong predictors of all-cause 30-day mortality in a large cohort of CRE carriers developing infection after LT. (Figure presented.).
AB - Background: Management of infections due to carbapenemase-resistant Enterobacterales (CRE) in solid organ transplant (SOT) recipients remains a difficult challenge. The INCREMENT-SOT-CPE score has been specifically developed from SOT recipients to stratify mortality risk, but an external validation is lacking. Methods: Multicenter retrospective cohort study of liver transplant (LT) recipients colonized with CRE infection who developed infection after transplant over 7-year period. Primary endpoint was all-cause 30-day mortality from infection onset. A comparison between INCREMENT-SOT-CPE and other selected scores was performed. A two-level mixed effects logistic regression model with random effects for the center was fitted. Performance characteristics at optimal cut-point were calculated. Multivariable Cox regression analysis of risk factors for all-cause 30-day mortality was carried out. Results: Overall, 250 CRE carriers developed infection after LT and were analyzed. The median age was 55 years (interquartile range [IQR]: 46–62) and 157 were males (62.8%). All-cause 30-day mortality was 35.6%. A sequential organ failure assessment (SOFA) score ≥ 11 showed a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 69.7%, 76.4%, 62.0%, 82.0%, and 74.0%, respectively. An INCREMENT-SOT-CPE ≥ 11 reported a sensitivity, specificity, PPV, NPV, and accuracy of 73.0%, 62.1%, 51.6%, 80.6% and 66.0%, respectively. At multivariable analysis acute renal failure, prolonged mechanical ventilation, INCREMENT-SOT-CPE score ≥ 11 and SOFA score ≥ 11 were independently associated with all-cause 30-day mortality, while a tigecycline-based targeted regimen was found to be protective. Conclusions: Both INCREMENT-SOT-CPE ≥ 11 and SOFA ≥ 11 were identified as strong predictors of all-cause 30-day mortality in a large cohort of CRE carriers developing infection after LT. (Figure presented.).
KW - CRE infection
KW - INCREMENT-SOT-CPE score
KW - SOT
KW - liver transplantation
UR - https://www.scopus.com/pages/publications/85149382709
U2 - 10.1111/tid.14036
DO - 10.1111/tid.14036
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C2 - 36880576
AN - SCOPUS:85149382709
SN - 1398-2273
VL - 25
JO - Transplant Infectious Disease
JF - Transplant Infectious Disease
IS - 2
M1 - e14036
ER -