1.“HAR/S”, the Product of Heart Rate, Age, and Respiratory Rate Divided by Systolic Blood Pressure, as a New Index for Detecting Infection in Patients with Impaired Consciousness
Yasuhiro NISHIMOTO ; Tsuyoshi HATAD ; Shuichi KOBAYASHI
Journal of the Japanese Association of Rural Medicine 2019;68(4):450-459
Infection is a known cause of impaired consciousness. Sometimes, the absence of fever delays diagnosis and treatment of infections in patients with impaired consciousness. This study aimed to identify a better index than body temperature for detecting infection in patients with impaired consciousness by using area under the receiver operating characteristic (AUROC) curves (≥ 0.7 was significant) and stratum-specific likelihood ratios (SSLRs, <0.2 or >5 was significant) according to patients’ vital signs (blood pressure, heart rate, body temperature, respiratory rate, and SpO2) or age. Of the 1,853 consecutive patients with impaired consciousness aged ≥15 years who were transported to our hospital between 2011 and 2014, 451 (24.3%) had infection. The AUROC for body temperature was 0.701 for diagnosing infection, whereas the AUROCs for other vital signs were < 0.7. Because no strata of body temperature showed values < 0.2 for diagnosing infection, we could not exclude infection in patients with impaired consciousness with low body temperatures. Next, we developed a novel index called HAR/S, the product of heart rate (beats/min), age (years), and respiratory rate (breaths/min) divided by systolic blood pressure (mmHg). The AUROC for HAR/S was 0.809 for diagnosing infection; this value was higher than that for body temperature; the SSLR for HAR/S <700 was 0.190 for diagnosing infections, which was <0.2. HAR/S ≥700 can be a new index for detecting infections in patients with impaired consciousness regardless of their body temperature, with sensitivity, specificity, and negative predictive values of 0.911, 0.468, and 0.941, respectively.