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Identifying patients with bacterial infections using a combination of C-reactive protein, procalcitonin, TRAIL and IP-10 in the emergency department: a prospective observational cohort study.
Clin Microbiol Infect. 2018 Sep 27;:
Authors: van der Does Y, Rood PPM, Ramakers C, Schuit SCE, Patka P, van Gorp ECM, Limper M
Abstract
OBJECTIVES: To effectively reduce the unnecessary use of broad spectrum antibiotics in the emergency department(ED), patients with bacterial infections need to be identified accurately. We investigated the diagnostic value of a combination of biomarkers for bacterial infections CRP and PCT, together with biomarkers for viral infections, TRAIL and IP-10, in identifying suspected and confirmed bacterial infections in a general ED population with fever.
METHODS: This is a sub-study in the HiTEMP cohort. Patients with fever were included during ED triage, and blood samples were obtained. Using both diagnostics and expert panel analysis, all patients were classified as having either suspected or confirmed bacterial infections, or non-bacterial disease. Using multivariable logistic regression analysis, three biomarker models were analyzed, model 1:(CRP,TRAIL,IP-10), model 2:(PCT,TRAIL,IP-10) and model 3:(CRP, PCT, TRAIL,IP-10).
RESULTS: A total of 315 patients were included, of whom 228 patients had a suspected or confirmed bacterial infection. The areas under the curve for the combined models were, for model 1: 0.730(95%CI 0.665-0.795), for model 2: 0.748 (95%CI 0.685-0.811), and for model 3: 0.767(95%CI 0.704-0.829).
CONCLUSIONS: These findings show that a combination of CRP, PCT, TRAIL and IP-10 can identify bacterial infections with higher accuracy than single biomarkers and combinations of a single bacterial biomarkers combined with TRAIL and IP-10.
PMID: 30268671 [PubMed - as supplied by publisher]