| Objective:To understand the distribution of pathogenic bacteria in bacterial bloodstream infection(BSI)or spontaneous bacterial peritonitis(SBP),discuss the diagnostic value of WBC,NEU%,CRP and PCT in bacterial bloodstream infection(BSI)and spontaneous bacterial peritonitis(SBP).Methods:The method of diagnostic test evaluation was adopted in this paper to research from the two aspects of bacterial bloodstream infection and spontaneous bacterial peritonitis.The hospitalized patients of the Third People 's Hospital of Taiyuan City in July 2014-October 2016 were recruited as our research objects,The patients were divided into case and control group according to the positive culture of bacteria and obvious clinical signs.Blood culture was performed with reference to the CLSIM 47 Recommended Practice,and ascites collection was performed with reference to the relevant guidelines of the European Liver Society,The WBC,NEU%,CRP,and PCT were detected within 24 hours,then the statistical analysis were performed as follows:(1)Described the distribution of pathogens in bacterial bloodstream infection and spontaneous bacterial peritonitis;(2)The WBC,NEU%,CRP and PCT levels were compared between the case group and the control group by wilcoxon rank sum test.(3)The WBC,NEU%,CRP and PCT levels were compared between the group of Gram-positive bacteria and Gram-negative bacteria by wilcoxon rank sum test.(4)Described the ROC curve to determine the best threshold,used the area under the ROC curve,test of validity,and benifits to evaluate WBC,NEU%,CRP,PCT and joint test(parallel test)in the diagnosis of bacterial bloodstream infections and spontaneous bacterial peritonitis.Results:(1)The value of the WBC,NEU%,CRP and PCT in the diagnosis of bacterial bloodstream infections: The 128 bacterial bloodstream infected cases who were diagnosed by bacterial etiology were selected as the bacterial BSI group,including 88 males and 40 females,and their average age were(49.48 ± 19.33)years old,The non-BSI patients with a total of 290 cases were choosed as control group,including 191 males and 99 females,and their average age were(49.15 ±17.53)years old.The bacterial BSI group and the control group performed double sets of blood culture bilateral,WBC,NEU%,CRP,and PCT.the results showed:(1)In the bacterial BSI group,the Gram-negative bacteria accounted for 74.22%,mainly included: Escherichia coli(31.3%),Maltese Bruce(21.9%),Klebsiella pneumoniae(12.5%),and so on,the Gram-positive bacteria accounted for 25.78%,mainly included:Staphylococcus epidermidis(4.2%),Enterococcus faecium(4.2%),Staphylococcus aureus(4.2%),and so on;(2)The difference in the levels of NEU%,CRP,and PCT between the bacterial BSI group and the control group were significant(P<0.05).there were no significant difference in the levels of WBC between bacterial BSI group and control group(P>0.05);(3)There were no significant difference in the levels of WBC,NEU%,and CRP between the Gram-positive bacteria and the Gram-negative in bacterial BSI group(P> 0.05).The difference in PCT levels between the two groups were significant(P <0.05);(4)The area under the ROC curve of WBC,NEU%,CRP,PCT,and four joint tests were sorted as followed: four joint tests(0.820),PCT(0.793),CRP(0.666),NEU %(0.650),and WBC(0.546).The authenticity index included sensitivity,specificity,Jordan index,positive likelihood ratio,and negative likelihood ratio were respectively: WBC(33.06%,75.52%,0.0858,1.35,0.89),NEU %(38.71%,91.72%,0.3043,4.68,0.67),CRP(73.39%,54.48%,0.2787,1.61,0.49),PCT(70.16%,87.59%,0.557,5.65,0.34)and four joint(67.7%,89.7%,0.574,6.57,0.36);The benefits index included positive predictive value and negative predictive value were respectively: WBC(35.25%,35.25%),NEU %(65.79%,65.79%),CRP(39.58%,39.58%),PCT(70%,70%),and four joint detection(74.14%,86.09%).(5)The area under the ROC curve was in descending order as followed: four joint detection,PCT,CRP,NEU%,and WBC.Then with the comparison between the two adjacent projects in Z test showed that the difference of the area under ROC curve between WBC and NEU %,NEU % and CRP,WBC and CRP,WBC and PCT,NEU % and PCT,CRP and PCT was statistical significant(P < 0.05).(2)The value of the WBC,NEU%,CRP and PCT in the diagnosis of spontaneous bacterial peritonitis.The 50 spontaneous bacterial peritonitis cases who were diagnosed by bacterial etiology were selected as the SBP group,including 39 males,11 females,and their average age were 51.87 ± 10.31 years old,The non-SBP patients with a total of 232 cases were choosed as control group,including 157 males and 75 females,and their average age were(52.44 ± 10.89)years old.The SBP and non-SBP groups were tested for ascitic fluid culture,WBC,NEU %,CRP,and PCT,the results showed:(1)In the SBP group,the Gram-negative bacteria accounted for 62.00%,mainly included e.coli(40%),klebsiella pneumoniae(12%),and so on,the Gram-positive bacteria accounted for 38.00%,mainly included: epidermis staphylococcus(10.00%),coriolis staphylococcus(8.00%),golden yellow staphylococcus(2.00%),and so on;(2)The difference in the levels of WBC,NEU%,CRP,PCT between the SBP group and the non-SBP group were significant(P <0.05).(3)There were no significant difference in the levels of WBC,NEU%,and CRP between the Gram-positive bacteria and the Gram-negative in the SBP group(P> 0.05).The difference in PCT levels between the two groups were significant(P <0.05);(4)The area under the ROC curve of WBC,NEU%,CRP,PCT,and four joint tests were sorted as followed : PCT(0.799),four joint detection(0.760),CRP(0.734),NEU %(0.606),and WBC(0.599);The authenticity index includes sensitivity,specificity,Jordan index,positive likelihood ratio,and negative likelihood ratio,were respectively: WBC(51.02%,68.97%,0.1999,1.64,0.71),NEU %(38.78%,85.34%,0.2412,2.65,0.72),CRP(77.55%,67.98%,0.4553,2.42,0.33),PCT(71.43%,73.71%,0.4514,2.72,0.387),the four joint tests(61.2%,89.2%,0.504,5.67,0.43);The benefits index included positive predictive value and negative predictive value were respectively:WBC(26.97%,26.97%),NEU %(45.45%,45.45%),CRP(35.85%,35.85%),PCT(35.79%,91.44%),and four joint tests(54.55%,91.19%).(5)The area under the ROC curve was in descending order as followed: PCT,four joint detection,CRP,NEU% and WBC.Then with the comparison between the two adjacent projects in Z test showed that the difference of the area under ROC curve between WBC and NEU%,CRP and four joint detection,CRP and PCT,four joint tests and PCT were no statistical significant(P> 0.05).There were significant difference between WBC,NEU% and CRP,four joint tests,PCT(P <0.05).Conclusion:(1)In the bacterial bloodstream infection,the Gram-negative bacteria accounted for 74.22%,mainly included the Escherichia coli,Maltese Bruce bacteria,Klebsiella pneumoniae,the Gram-positive bacteria accounted for 25.78%,mainly included the Staphylococcus epidermidis,Cocci bacteria and staphylococci;In the spontaneous bacterial peritonitis,the Gram-negative bacteria accounted for 62.00%,mainly included the Escherichia coli,Klebsiella pneumoniae,the Gram-positive bacteria accounted for 38.00%,mainly included Staphylococcus epidermidis,Staphylococcus aureus,Staphylococcus aureus.(2)The NEU%,CRP,and PCT had a diagnostic significance in the bacterial bloodstream infected;the WBC,NEU%,CRP,and PCT had a diagnostic significance in the spontaneous bacterial peritonitis.(3)In the bacterial bloodstream infection and spontaneous bacterial peritonitis,the levels of PCT were significantly higher in Gram-negative bacteria infection than in Gram-positive bacteria infection,while the levels of WBC,NEU%,and CRP had no significantly different between Gram-positive bacteria and Gram-negative bacteria;(4)In the bacterial bloodstream infection,the diagnostic value assessed by the area under the ROC curve were sorted(from large to small)as followed: four joint tests(parallel),PCT,CRP,NEU %,and WBC;the diagnostic value of four joint tests were significantly better than single test,and the difference of diagnostic value in single test PCT,CRP,NEU%,and WBC was significant.Four joint tests(parallel)and PCT were significantly better than WBC,NEU%,and CRP in the authenticity and benefits;(5)In the spontaneous bacterial peritonitis,the diagnostic value assessed by the area under the ROC curve were sorted(from large to small)as followed: PCT,four joint tests,CRP,NEU % and WBC.PCT,four joint tests,CRP(no difference between the three)diagnostic value were significantly better than WBC,NEU%(no difference between the two);PCT was superior to four joint tests(parallel),CRP,NEU% and WBC in terms of authenticity;four joint tests(parallel)were superior to single test in positive predictions,whereas CRP was better than four joint tests,PCT,NEU% and WBC in negative predictions. |
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