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Evaluation of the clinical diagnostic value of traditional inflammatory markers and novel biomarkers in intracellular bacterial bloodstream infections
Cytokine ( IF 3.7 ) Pub Date : 2020-12-01 , DOI: 10.1016/j.cyto.2020.155238 Mei-Fang Lin 1 , Bin Sun 1 , Zhi-Yong Liu 2 , Peng Tang 3 , Li-Jun Zhang 1 , Yun-Ying Wang 1
Cytokine ( IF 3.7 ) Pub Date : 2020-12-01 , DOI: 10.1016/j.cyto.2020.155238 Mei-Fang Lin 1 , Bin Sun 1 , Zhi-Yong Liu 2 , Peng Tang 3 , Li-Jun Zhang 1 , Yun-Ying Wang 1
Affiliation
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OBJECTIVES
The clinical symptoms of the patients with intracellular bacterial bloodstream infections (Intra-bac BSIs) are atypical, and no early and accurate diagnostic biomarkers exist, which can easily lead to misdiagnosis, inappropriate and delayed treatment. Therefore, it is imperative to find novel biomarkers to help clinical diagnosis of Intra-bac BSIs. The present study was initiated to evaluate the diagnostic values of traditional inflammatory biomarkers (PCT, WBC and NEU% in identifying the patients with Intra-bac BSIs, and to further explore into the possibility of using suPAR and sCD14-ST as novel biomarkers for Intra-bac BSIs. METHODS
A multi-center retrospective study was conducted in three teaching hospitals in Chongqing. A total of 146 cases with BSIs, including 73 cases with Intra-bac BSIs and 73 cases with extracellular bacterial BSIs (Extra-bac BSIs) were enrolled in the retrospective study. We then prospectively enrolled 34 patients with Intra-bac BSIs, 34 patients with Extra-bac BSIs, 34 patients with viral infection and with normal medical examination results as a control group for further detection of sCD14-ST and suPAR by ELISA. RESULTS
PCT levels, WBC counts and NEU% in patients with Intra-bac BSIs were not increased or minimally increased, they were significantly lower than that with Extra-bac BSIs (P < 0.05), especially those with the Brucella bacterial BSIs, demonstrated a respective negative rate of 84% and 92% for PCT and WBC counts. In the prospective study, the levels of suPAR and sCD14-ST in both the Intra-bac BSIs and the Extra-bac BSIs groups were significantly higher than those in the viral infection group and normal control group (P < 0.05). The areas under the curve (AUC) of Intra-bac BSIs were 0.830 for suPAR, and 0.855 for sCD14-ST. The sensitivity, specificity, Youden's index for suPAR and sCD14-ST were respectively 76.5%, 88.2%, 0.647 and 94.1%, 64.7%, 0.588. CONCLUSIONS
Our multi-center study demonstrated that while the traditional inflammatory markers such as PCT, WBC counts, NEU% could not be served as promising diagnostic markers for Intra-bac BSIs; CRP can help guide the diagnosis of Intra-bac BSIs; Both suPAR and sCD14-ST could be considered as novel diagnostic biomarkers for Intra-bac BSIs as they showed good diagnostic accuracies in Intra-bac BSIs, especially suPAR.
中文翻译：
细胞内细菌性血流感染中传统炎症标志物和新型生物标志物的临床诊断价值评价
目的细胞内细菌性血流感染（Intra-bac BSI）患者的临床症状不典型，不存在早期准确的诊断生物标志物，容易导致误诊、不恰当和延误治疗。因此，迫切需要寻找新的生物标志物来帮助 Intra-bac BSI 的临床诊断。本研究旨在评估传统炎症生物标志物（PCT、WBC 和 NEU%）在识别 Intra-bac BSI 患者中的诊断价值，并进一步探讨使用 suPAR 和 sCD14-ST 作为 Intra-bac BSI 的新型生物标志物的可能性。 -bac BSIs 方法在重庆市3家教学医院进行多中心回顾性研究，共146例BSIs，包括73例Intra-bac BSIs和73例细胞外BSIs（Extra-bac BSIs）被纳入回顾性研究。然后我们前瞻性地招募了34例Intra-bac BSI患者、34例Extra-bac BSI患者、34例病毒感染且体检结果正常的患者作为对照组，进一步通过ELISA检测sCD14-ST和suPAR。结果 Intra-bac BSIs患者的PCT水平、WBC计数和NEU%没有增加或略有增加，显着低于Extra-bac BSIs（P < 0.05），尤其是布鲁氏菌BSIs患者，表明PCT 和 WBC 计数的阴性率分别为 84% 和 92%。在前瞻性研究中，Intra-bac BSI和Extra-bac BSI组suPAR和sCD14-ST水平均显着高于病毒感染组和正常对照组（P < 0.05）。Intra-bac BSI 的曲线下面积 (AUC) 对于 suPAR 为 0.830，对于 sCD14-ST 为 0.855。suPAR和sCD14-ST的敏感性、特异性、约登指数分别为76.5%、88.2%、0.647和94.1%、64.7%、0.588。结论 我们的多中心研究表明，虽然传统的炎症标志物如 PCT、WBC 计数、NEU% 不能作为有希望的 Intra-bac BSI 诊断标志物；CRP 可以帮助指导 Intra-bac BSI 的诊断；suPAR 和 sCD14-ST 均可被视为 Intra-bac BSI 的新型诊断生物标志物，因为它们在 Intra-bac BSI，尤其是 suPAR 中显示出良好的诊断准确性。
更新日期：2020-12-01
中文翻译：
细胞内细菌性血流感染中传统炎症标志物和新型生物标志物的临床诊断价值评价
目的细胞内细菌性血流感染（Intra-bac BSI）患者的临床症状不典型，不存在早期准确的诊断生物标志物，容易导致误诊、不恰当和延误治疗。因此，迫切需要寻找新的生物标志物来帮助 Intra-bac BSI 的临床诊断。本研究旨在评估传统炎症生物标志物（PCT、WBC 和 NEU%）在识别 Intra-bac BSI 患者中的诊断价值，并进一步探讨使用 suPAR 和 sCD14-ST 作为 Intra-bac BSI 的新型生物标志物的可能性。 -bac BSIs 方法在重庆市3家教学医院进行多中心回顾性研究，共146例BSIs，包括73例Intra-bac BSIs和73例细胞外BSIs（Extra-bac BSIs）被纳入回顾性研究。然后我们前瞻性地招募了34例Intra-bac BSI患者、34例Extra-bac BSI患者、34例病毒感染且体检结果正常的患者作为对照组，进一步通过ELISA检测sCD14-ST和suPAR。结果 Intra-bac BSIs患者的PCT水平、WBC计数和NEU%没有增加或略有增加，显着低于Extra-bac BSIs（P < 0.05），尤其是布鲁氏菌BSIs患者，表明PCT 和 WBC 计数的阴性率分别为 84% 和 92%。在前瞻性研究中，Intra-bac BSI和Extra-bac BSI组suPAR和sCD14-ST水平均显着高于病毒感染组和正常对照组（P < 0.05）。Intra-bac BSI 的曲线下面积 (AUC) 对于 suPAR 为 0.830，对于 sCD14-ST 为 0.855。suPAR和sCD14-ST的敏感性、特异性、约登指数分别为76.5%、88.2%、0.647和94.1%、64.7%、0.588。结论 我们的多中心研究表明，虽然传统的炎症标志物如 PCT、WBC 计数、NEU% 不能作为有希望的 Intra-bac BSI 诊断标志物；CRP 可以帮助指导 Intra-bac BSI 的诊断；suPAR 和 sCD14-ST 均可被视为 Intra-bac BSI 的新型诊断生物标志物，因为它们在 Intra-bac BSI，尤其是 suPAR 中显示出良好的诊断准确性。
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