Clinical Characteristics and Laboratory Biomarkers in ICU-admitted Septic Patients with and without Bacteremia: A Predictive Analysis

Abstract

AbstractBackgroundFew studies have investigated the diagnostic utilities of biomarkers for predicting bacteremia among septic patients admitted to intensive care units (ICU). Therefore, this study evaluated the prediction power of laboratory biomarkers to utilize those markers with high performance to optimize the predictive model for bacteremia.MethodsA retrospective cross-sectional study was conducted at the ICU department of Gyeongsang National University Changwon Hospital in 2019. Adult patients qualifying SEPSIS-3 (increase in sequential organ failure score ≥ 2) criteria with at least two sets of blood culture were selected. Collected data was initially analyzed independently to identify the significant predictors, which was then used to build the multivariable logistic regression (MLR) model.ResultsA total of 218 patients with 48 cases of true bacteremia were analyzed in this research. Both CRP and PCT showed a substantial area under the curve (AUC) value for discriminating bacteremia among septic patients (0.757 and 0.845, respectively). To further enhance the predictive accuracy, we combined PCT, bilirubin, neutrophil-lymphocyte ratio (NLR), platelets, lactic acid, erythrocyte sedimentation rate (ESR), and Glasgow Coma Scale (GCS) score to build the predictive model with an AUC of 0.907 [0.843–0.956]. In addition, a high association between bacteremia and mortality rate was discovered through the survival analysis (P=0.004).ConclusionsWhile PCT is certainly a useful index for distinguishing patients with and without bacteremia by itself, our MLR model indicates that the accuracy of bacteremia prediction substantially improves by the combined use of PCT, bilirubin, NLR, platelets, lactic acid, ESR, and GCS score.