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Open Access Highly Accessed Open Badges Research article

Comparison of severity of illness scoring systems for patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa

Alexandre R Marra12*, Gonzalo ML Bearman2, Richard P Wenzel2 and Michael B Edmond2

Author Affiliations

1 Division of Infectious Diseases, Universidade Federal de São Paulo, Brasil (UNIFESP-EPM)/Hospital São Paulo (HSP), Brazil

2 Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Virginia, USA

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BMC Infectious Diseases 2006, 6:132  doi:10.1186/1471-2334-6-132

Published: 17 August 2006



Several acute illness severity scores have been proposed for evaluating patients on admission to intensive care units but these have not been compared for patients with nosocomial bloodstream infection (nBSI). We compared three severity of illness scoring systems for predicting mortality in patients with nBSI due to Pseudomonas aeruginosa.


We performed a historical cohort study on 63 adults in intensive care units with P. aeruginosa monomicrobial nBSI.


The Acute Physiology, Age, Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiologic Score (SAPS II), were calculated daily from 2 days prior through 2 days after the first positive blood culture. Calculation of the area under the receiver operating characteristic (ROC) curve confirmed that APACHE II and SAPS II at day -1 and SOFA at day +1 were better predictors of outcome than days -2, 0 and day 2 of BSI. By stepwise logistic regression analysis of these three scoring systems, SAPS II (OR: 13.03, CI95% 2.51–70.49) and APACHE II (OR: 12.51, CI95% 3.12–50.09) on day -1 were the best predictors for mortality.


SAPS II and APACHE II are more accurate than the SOFA score for predicting mortality in this group of patients at day -1 of BSI.