Early Biomarker-Guided Prediction of Bloodstream Infection in Critically Ill Patients: C-Reactive Protein, Procalcitonin, and Leukocytes

Frederik Boetius Hertz*, Magnus G Ahlström, Morten H Bestle, Lars Hein, Thomas Mohr, Jens D Lundgren, Tina Galle, Mads Holmen Andersen, Daniel Murray, Anne Lindhardt, Theis Skovsgaard Itenov, Jens Ulrik Staehr Jensen

*Corresponding author for this work
1 Citation (Scopus)

Abstract

Background: Bloodstream infections (BSIs) often lead to critical illness and death. The primary aim of this study was to determine the diagnostic accuracy of the biomarkers C-reactive protein (CRP), procalcitonin (PCT), and leukocyte count for the diagnosis of BSI in critically ill patients.

Methods: This was a nested case-control study based on the Procalcitonin And Survival Study (PASS) trial (n = 1200). Patients who were admitted to the intensive care unit (ICU) <24 hours, and not expected to die within <24 hours, were recruited. For the current study, we included patients with a BSI within ±3 days of ICU admission and matched controls without a BSI in a 1:2 ratio. Diagnostic accuracy for BSI for the biomarkers on days 1, 2, and 3 of ICU admission was assessed. Sensitivity, specificity, and negative and positive predictive values were calculated for prespecified thresholds and for a data-driven cutoff.

Results: In total, there were 525 patients (n = 175 cases, 350 controls). The fixed low threshold for all 3 biomarkers (CRP = 20 mg/L; leucocytes = 10 × 10 9/L; PCT = 0.4 ng/mL) resulted in negative predictive values on day 1: CRP = 0.91; 95% CI, 0.75-1.00; leukocyte = 0.75; 95% CI, 0.68-0.81; PCT = 0.91; 95% CI, 0.84-0.96). Combining the 3 biomarkers yielded similar results as PCT alone ( P  = .5).

Conclusions: CRP and PCT could in most cases rule out BSI in critically ill patients. As almost no patients had low CRP and ∼20% had low PCT, a low PCT could be used, along with other information, to guide clinical decisions.

Original languageEnglish
Article numberofac467
JournalOpen Forum Infectious Diseases
Volume9
Issue number10
Pages (from-to)ofac467
ISSN2328-8957
DOIs
Publication statusPublished - Oct 2022

Keywords

  • bloodstream infection
  • BSI
  • CRP
  • leukocyte
  • PCT

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