Shuixiang Deng1, Jiamin Gao1,2, Zhiyong Zhao3, Mi Tian1, Yuming Li1, Ye Gong1. 1. Department of Critical Care Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, China. 2. Department of Emergency Care, Huashan Hospital Affiliated to Fudan University, Shanghai, China. 3. Department of Critical Care Medicine, First Affiliated Hospital of Xiamen University, Fujian, China.
Abstract
Background: This study was performed to investigate the combination of admission serum procalcitonin (PCT) and albumin (alb) concentrations as a diagnostic predictor for discriminating patients with nosocomial blood stream infection (BSI) among those with spontaneous intra-cerebral hemorrhage (ICH). Methods: We conducted a retrospective study on patients with ICH and hospital-acquired BSI. Clinical and microbiological data were compared in patients who experienced nosocomial BSI during a hospital stay and those who did not. Multivariable logistic regression analyses were used to identify independent risk factors for nosocomial BSI. A receiver operating characteristic (ROC) curve analysis was performed to compare the predictive accuracy of the albumin:PCT ratio. Results: Patients with nosocomial BSI had lower albumin:PCT ratios than those without BSI (11.739 [3.192-38.452] versus 200.000 [40.634-417.500]; p < 0.001). Multivariable logistic regression analysis revealed that the albumin:PCT ratio (odds ratio [OR] 1.006; 95% confidence interval [CI] 1.002-1.011; p = 0.001], white blood cell count (OR 1.129; 95% CI 1.044-1.220; p = 0.002), and shock (OR 4.504; 95% CI 1.774-11.435; p = 0.002) were independent predictors of nosocomial BSI, allowing distinction of patients with the infection from those without. The area under the ROC curve for the albumin:PCT ratio was 0.830 (95% CI 0.768-0.892; p < 0.001). The cut-off value of the albumin:PCT ratio was <1.087 with a sensitivity of 90.6% and a specificity of 98.8%. In the subgroup of 85 patients with nosocomial BSI, the albumin:PCT ratio in patients with shock was lower than that in those without shock (7.154 [2.975-26.267] vs 28.000 [3.818-57.812]; p = 0.027). Conclusion: The albumin:PCT ratio can be used as an early diagnostic predictor for nosocomial BSI in patients with ICH. Additionally, BSI patients with lower albumin:PCT ratios are more likely to experience shock. The albumin:PCT ratio is expected to be a rapid and low-cost tool for clinical practice.
Background: This study was performed to investigate the combination of admission serum procalcitonin (PCT) and albumin (alb) concentrations as a diagnostic predictor for discriminating patients with nosocomial blood stream infection (BSI) among those with spontaneous intra-cerebral hemorrhage (ICH). Methods: We conducted a retrospective study on patients with ICH and hospital-acquired BSI. Clinical and microbiological data were compared in patients who experienced nosocomial BSI during a hospital stay and those who did not. Multivariable logistic regression analyses were used to identify independent risk factors for nosocomial BSI. A receiver operating characteristic (ROC) curve analysis was performed to compare the predictive accuracy of the albumin:PCT ratio. Results:Patients with nosocomial BSI had lower albumin:PCT ratios than those without BSI (11.739 [3.192-38.452] versus 200.000 [40.634-417.500]; p < 0.001). Multivariable logistic regression analysis revealed that the albumin:PCT ratio (odds ratio [OR] 1.006; 95% confidence interval [CI] 1.002-1.011; p = 0.001], white blood cell count (OR 1.129; 95% CI 1.044-1.220; p = 0.002), and shock (OR 4.504; 95% CI 1.774-11.435; p = 0.002) were independent predictors of nosocomial BSI, allowing distinction of patients with the infection from those without. The area under the ROC curve for the albumin:PCT ratio was 0.830 (95% CI 0.768-0.892; p < 0.001). The cut-off value of the albumin:PCT ratio was <1.087 with a sensitivity of 90.6% and a specificity of 98.8%. In the subgroup of 85 patients with nosocomial BSI, the albumin:PCT ratio in patients with shock was lower than that in those without shock (7.154 [2.975-26.267] vs 28.000 [3.818-57.812]; p = 0.027). Conclusion: The albumin:PCT ratio can be used as an early diagnostic predictor for nosocomial BSI in patients with ICH. Additionally, BSI patients with lower albumin:PCT ratios are more likely to experience shock. The albumin:PCT ratio is expected to be a rapid and low-cost tool for clinical practice.