Diagnostic Value Of PCT,NEUT%,LYMPH%,CRP,PLT,WBC,ESR For Bloodstream Infection

Objective:Seven common laboratory inflammation indicators(procalcitonin(PCT),white blood cell count(WBC),quantitative granulocyte ratio(NEUT%),lymphocyte ratio(LYMPH%),platelet count(PLT),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP))in the inpatients who underwent blood culture examinations in the department of Clinical Laboratory in our hospital from January 2012 to July 2018were retrospectively analyzed,and systematically evaluated the clinical value of assisted diagnosis for blood flow infection.Methods:1580 hospitalized patients who underwent blood culture examination in our hospital from January 2012 to July 2018 were selected as the research subjects.According to the blood culture results,they were divided into Gram-negative bacilli group(509 case),Gram-positive cocci group(197 case)and negative control group.(868 case)Compare the differences of PCT,WBC,NEUT%,LYMPH%,PLT,ESR,and CRP levels between the three groups.Six cases of fungi were too small to be counted.In addition,the SPSS statistical software was used to map the corresponding inflammatory indicators to assist in the diagnosis of the receiver operating characteristic curve(ROC curve)of bloodstream infection to systematically evaluate the value of each inflammatory factor in the auxiliary diagnosis of clinical bloodstream infection.(1)Blood culture The blood culture blood culture specimens are immediately injected into the resin blood culture bottle and sent to the laboratory,and placed in the BC120 automatic bacterial culture instrument for culture.If there is a positive alarm,the blood culture specimens are transferred to the culture medium for further cultivation,and the colonies are formed.In strict accordance with the manufacturer’s instructions,the VITEK 2-compact automatic microbial identification instrument was used to identify and analyze the pathogens of bloodstream infection,and the calibration and quality of the instrument were in a controlled state.(2)PCT The French BIOMERIEUX VIDAS30 automatic immunoassay analyzer and supporting reagents were used for detection,and the principle of immunofluorescence analysis was used for detection.The normal reference value was0-0.5 ng/mL.(3)CRP Using the American Beckman Coulter IMMAGE800 specific protein analysis system and supporting reagents,the detection is based on the principle of scattering turbidity.The normal reference value is 0-8 mg/L.(4)ESR Using the Italian Microsed System automatic erythrocyte sedimentation apparatus,the infrared reference method was used to detect the normal reference value of 0-20 mm/h(female),0-15 mm/h(male).(5)Blood routine Using the American Beckman DXH800 automatic blood cell analyzer,white blood cells(WBC)count normal reference value(3.5-9.5)×10~9/L,neutrophil percentage(NEUT%)normal reference value 40%-75%,lymphocytes The ratio(LYMPH%)is normal reference value 20%-50%,and the platelet value(PLT)normal reference value is 125-350×10~9/L.(6)Statistical methods Statistical analysis was performed using SPSS 17.0 software.Kolmogorov-Smimov was used for normality test for continuous measurement data,and median[M(P25 to P75)]was used for non-normal distribution measurement data.Use non-parametric test,a two-sample rank sum test(M-W test)was used for comparison between the two groups,and a multi-group comparison was performed using a rank sum test(K-W test)of multiple independent samples.The measured data of normal distribution is expressed by mean±standard deviation(x±sd);Taking the sensitivity as the ordinate and plotting the ROC curve with the 1-specificity as the abscissa.Test level=0.05.Results:(1)The PCT levels of the Gram-negative bacillus group,the Gram-positive cocci group,and the negative control group were as follows:5.99(0.58~31.54)ng/mL,1.52(0.23~5.69)ng/mL,0.49(0.22~3.00)ng/mL;WBC level is 11.15(7.40~16.22)×10~9/L,11.85(7.78~16.33)×10~9/L,9.4(6.90~13.25)×10~9/L;NEUT%level is 89.50(82.10~93.10)%,87.45(78.50~92.05)%,81.80(73.20~87.80)%;LYMPH%level5.90(3.20~10.80)%,7.00(3.78~12.43)%,10.20(6.40~16.10)%;PLT level is163.00(111.75~288.00)×109/L,168.00(118.75~239.50)×10~9/L,200(140.25~266.00)×10~9/L;ESR level is 55.5±4.2 mm/h,56.2±8.4 mm/h,49.2±3.0 mm/h;CRP level is112.00(48.10~172.00)mg/L,74.00(25.40~124.00)mg/L,55.50(16.70~111.00)mg/L.(2)The levels of inflammatory markers were not the same among the three groups.The PCT and CRP indicators were significantly higher in the Gram-negative group than in the Gram-positive group,while the NEUT%,WBC,LYMPH%,PLT,and ESR levels were not significant difference.In the comparison between the three groups,the difference of PCT,CRP and NEUT%between Gram-positive and Gram-negative bacteria was significant(P<0.05),while the difference of ESR,WBC,LYMPH%and PLT was not significant(P>0.05);Gram-negative bacteria and negative control bacteria PCT,CRP,NEUT%,LYMPH%,PLT were significantly different(P<0.05)),WBC,ESR difference was not significant(P>0.05);Gram-positive There was no significant difference in PCT,CRP,NEUT%and ESR between the bacteria and the negative control group(P>0.05),WBC,LYMPH%,and PLT were significantly different(P<0.05).(3)The ROC curve analysis results of different inflammatory indexes indicated that the diagnostic efficiency of bloodstream infection induced by Gram-negative bacteria group was PCT,NEUT%,LYMPH%,CRP,PLT,WBC,ESR,and the area under the curve of PCT AUC 0.728,P=0.000,the best cut-off point 2.935 ng/mL,sensitivity64.00%,specificity 74.50%;NEUT%AUC 0.701,P=0.000,the best cut-off point86.25%,sensitivity 63.50%,specificity is 70.40%;LYMPH%AUC 0.677,P=0.000,the best cut-off point 6.35%,sensitivity 75.10%,specificity 54.00%;CRP AUC 0.662,P=0.000,the best cut-off point 85.8 mg/L,sensitivity was 61.00%,specificity was66.50%;AUC of PLT was 0.618,P=0.000,the best cutoff point was 189.5×10~9/L,sensitivity was 54.80%,specificity was 60.00%;WBC AUC 0.575,P=0.000,the best cut-off point is 14.57×10~9/L,the sensitivity is 32.30%,the specificity is 81.90%;the AUC of ESR is 0.555,the best cut-off point is 39.5 mm/h,the sensitivity is 61.50%,specific The degree is 51.70%,P=0.109.The diagnostic efficiency of different inflammatory markers for Gram-positive cocci-induced bloodstream infections was NEUT%,LYMPH%,PCT,WBC,CRP,PLT,ESR,with NEUT%AUC 0.636,P=0.000,the best cut-off point 87.35%,sensitivity 50.60%,specificity 70.40%;LYMPH%AUC 0.634,P=0.000,the best cut-off point 5.75%,sensitivity 79.00%,specificity 43.20%;PCT AUC 0.602,P=0.091,the best cut-off point 1.160 ng/mL,sensitivity 64.30%,specificity 62.80%;WBC AUC 0.599,P=0.000,the best cut-off point 11.25×10~9/L,sensitivity 55.60%,specificity is 63.00%;CRP AUC 0.549,P=0.188,the best cut-off point 4.69 mg/L,sensitivity 94.70%,specificity 9.60%;PLT AUC 0.570,P=0.005,the best cut-off point 131.5×10~9/L,the sensitivity was 79.70%,the specificity was 31.90%;the AUC of ESR,P=0.535,the best cut-off point 95 mm/h,the sensitivity was 2.00%,and the specificity was 89.60%.Conclusion:The diagnostic value of different inflammatory markers for bloodstream infection was different.In the comparison of the inflammatory index levels among the three groups,the PCT and CRP indexes were significantly higher in the Gram-negative group than in the Gram-positive group.PCT,NEUT%,LYMPH%,CRP,PLT,WBC have diagnostic significance for bloodstream infection caused by Gram-negative bacteria,but the diagnostic value of ESR is not obvious;NEUT%,LYMPH%,WBC,PLT are caused by Gram-positive bacteria Bloodstream infections have diagnostic significance,and the diagnostic value of PCT,ESR,and CRP is not significant.