Hospital-wide, dynamic, individualized prediction of central line-associated bloodstream infections-development and temporal evaluation of six prediction models
Abstract Background Central line-associated bloodstream infections (CLABSI) are preventable hospital-acquired infections. Predicting CLABSI helps improve early intervention strategies and enhance patient safety. Aim To develop and temporally evaluate dynamic prediction models for continuous CLABSI r...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-04-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-025-10854-1 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850172882927222784 |
|---|---|
| author | Elena Albu Shan Gao Pieter Stijnen Frank E. Rademakers Christel Janssens Veerle Cossey Yves Debaveye Laure Wynants Ben Van Calster |
| author_facet | Elena Albu Shan Gao Pieter Stijnen Frank E. Rademakers Christel Janssens Veerle Cossey Yves Debaveye Laure Wynants Ben Van Calster |
| author_sort | Elena Albu |
| collection | DOAJ |
| description | Abstract Background Central line-associated bloodstream infections (CLABSI) are preventable hospital-acquired infections. Predicting CLABSI helps improve early intervention strategies and enhance patient safety. Aim To develop and temporally evaluate dynamic prediction models for continuous CLABSI risk monitoring. Methods Data from hospitalized patients with central catheter(s) admitted to University Hospitals Leuven between 2014 and 2017 were used to develop five dynamic models (a landmark cause-specific model, two random forest models, and two XGBoost models) to predict 7-day CLABSI risk, accounting for competing events (death, discharge, and catheter removal). The models’ predictions were then combined using a superlearner model. All models were temporally evaluated on data from the same hospital from 2018 to 2020 using performance metrics for discrimination, calibration, and clinical utility. Findings Among 61629 catheter episodes in the training set, 1930 (3.1%) resulted in CLABSI, while in the test set of 44544 catheter episodes, 1059 (2.4%) experienced CLABSI. Among individual models, one XGBoost model achieved the highest AUROC of 0.748. Calibration was good for predicted risks up to 5%, while the cause-specific and XGBoost models overestimated higher predicted risks. The superlearner displayed a modest improvement in discrimination (AUROC up to 0.751) and better calibration than the cause-specific and XGBoost models, but worse than the random forest models. The models showed clinical utility to support standard care interventions (at risk thresholds between 0.5–4%), but not to support advanced interventions (at thresholds 15–25%). Conclusion Hospital-wide CLABSI prediction models offer clinical utility based on medium-risk thresholds. Clinical utility at present may be limited as the model performance deteriorated over time. |
| format | Article |
| id | doaj-art-72fab0ae421f48458e56624d98f3571a |
| institution | OA Journals |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj-art-72fab0ae421f48458e56624d98f3571a2025-08-20T02:19:58ZengBMCBMC Infectious Diseases1471-23342025-04-0125111210.1186/s12879-025-10854-1Hospital-wide, dynamic, individualized prediction of central line-associated bloodstream infections-development and temporal evaluation of six prediction modelsElena Albu0Shan Gao1Pieter Stijnen2Frank E. Rademakers3Christel Janssens4Veerle Cossey5Yves Debaveye6Laure Wynants7Ben Van Calster8Department of Development & Regeneration, KU LeuvenDepartment of Development & Regeneration, KU LeuvenManagement Information Reporting Department, University Hospitals LeuvenFaculty of Medicine, KU LeuvenVascular Access Specialty Team, University Hospitals LeuvenDepartment of Development & Regeneration, KU LeuvenDepartment of Cellular and Molecular Medicine, University Hospitals LeuvenDepartment of Development & Regeneration, KU LeuvenDepartment of Development & Regeneration, KU LeuvenAbstract Background Central line-associated bloodstream infections (CLABSI) are preventable hospital-acquired infections. Predicting CLABSI helps improve early intervention strategies and enhance patient safety. Aim To develop and temporally evaluate dynamic prediction models for continuous CLABSI risk monitoring. Methods Data from hospitalized patients with central catheter(s) admitted to University Hospitals Leuven between 2014 and 2017 were used to develop five dynamic models (a landmark cause-specific model, two random forest models, and two XGBoost models) to predict 7-day CLABSI risk, accounting for competing events (death, discharge, and catheter removal). The models’ predictions were then combined using a superlearner model. All models were temporally evaluated on data from the same hospital from 2018 to 2020 using performance metrics for discrimination, calibration, and clinical utility. Findings Among 61629 catheter episodes in the training set, 1930 (3.1%) resulted in CLABSI, while in the test set of 44544 catheter episodes, 1059 (2.4%) experienced CLABSI. Among individual models, one XGBoost model achieved the highest AUROC of 0.748. Calibration was good for predicted risks up to 5%, while the cause-specific and XGBoost models overestimated higher predicted risks. The superlearner displayed a modest improvement in discrimination (AUROC up to 0.751) and better calibration than the cause-specific and XGBoost models, but worse than the random forest models. The models showed clinical utility to support standard care interventions (at risk thresholds between 0.5–4%), but not to support advanced interventions (at thresholds 15–25%). Conclusion Hospital-wide CLABSI prediction models offer clinical utility based on medium-risk thresholds. Clinical utility at present may be limited as the model performance deteriorated over time.https://doi.org/10.1186/s12879-025-10854-1Bloodstream infectionRisk predictionCLABSIDynamic model |
| spellingShingle | Elena Albu Shan Gao Pieter Stijnen Frank E. Rademakers Christel Janssens Veerle Cossey Yves Debaveye Laure Wynants Ben Van Calster Hospital-wide, dynamic, individualized prediction of central line-associated bloodstream infections-development and temporal evaluation of six prediction models BMC Infectious Diseases Bloodstream infection Risk prediction CLABSI Dynamic model |
| title | Hospital-wide, dynamic, individualized prediction of central line-associated bloodstream infections-development and temporal evaluation of six prediction models |
| title_full | Hospital-wide, dynamic, individualized prediction of central line-associated bloodstream infections-development and temporal evaluation of six prediction models |
| title_fullStr | Hospital-wide, dynamic, individualized prediction of central line-associated bloodstream infections-development and temporal evaluation of six prediction models |
| title_full_unstemmed | Hospital-wide, dynamic, individualized prediction of central line-associated bloodstream infections-development and temporal evaluation of six prediction models |
| title_short | Hospital-wide, dynamic, individualized prediction of central line-associated bloodstream infections-development and temporal evaluation of six prediction models |
| title_sort | hospital wide dynamic individualized prediction of central line associated bloodstream infections development and temporal evaluation of six prediction models |
| topic | Bloodstream infection Risk prediction CLABSI Dynamic model |
| url | https://doi.org/10.1186/s12879-025-10854-1 |
| work_keys_str_mv | AT elenaalbu hospitalwidedynamicindividualizedpredictionofcentrallineassociatedbloodstreaminfectionsdevelopmentandtemporalevaluationofsixpredictionmodels AT shangao hospitalwidedynamicindividualizedpredictionofcentrallineassociatedbloodstreaminfectionsdevelopmentandtemporalevaluationofsixpredictionmodels AT pieterstijnen hospitalwidedynamicindividualizedpredictionofcentrallineassociatedbloodstreaminfectionsdevelopmentandtemporalevaluationofsixpredictionmodels AT frankerademakers hospitalwidedynamicindividualizedpredictionofcentrallineassociatedbloodstreaminfectionsdevelopmentandtemporalevaluationofsixpredictionmodels AT christeljanssens hospitalwidedynamicindividualizedpredictionofcentrallineassociatedbloodstreaminfectionsdevelopmentandtemporalevaluationofsixpredictionmodels AT veerlecossey hospitalwidedynamicindividualizedpredictionofcentrallineassociatedbloodstreaminfectionsdevelopmentandtemporalevaluationofsixpredictionmodels AT yvesdebaveye hospitalwidedynamicindividualizedpredictionofcentrallineassociatedbloodstreaminfectionsdevelopmentandtemporalevaluationofsixpredictionmodels AT laurewynants hospitalwidedynamicindividualizedpredictionofcentrallineassociatedbloodstreaminfectionsdevelopmentandtemporalevaluationofsixpredictionmodels AT benvancalster hospitalwidedynamicindividualizedpredictionofcentrallineassociatedbloodstreaminfectionsdevelopmentandtemporalevaluationofsixpredictionmodels |