Albumin/Procalcitonin Ratio Is a Sensitive Early Marker of Nosocomial Blood Stream Infection in Patients with Intra-Cerebral Hemorrhage

Abstract

Abstract

Background:

This study was performed to investigate the combination of admission serum procalcitonin (PCT) and albumin (alb) concentrations as a diagnostic predictor for discriminating patients with nosocomial blood stream infection (BSI) among those with spontaneous intra-cerebral hemorrhage (ICH).

Methods:

We conducted a retrospective study on patients with ICH and hospital-acquired BSI. Clinical and microbiological data were compared in patients who experienced nosocomial BSI during a hospital stay and those who did not. Multivariable logistic regression analyses were used to identify independent risk factors for nosocomial BSI. A receiver operating characteristic (ROC) curve analysis was performed to compare the predictive accuracy of the albumin:PCT ratio.

Results:

Patients with nosocomial BSI had lower albumin:PCT ratios than those without BSI (11.739 [3.192–38.452] versus 200.000 [40.634–417.500]; p < 0.001). Multivariable logistic regression analysis revealed that the albumin:PCT ratio (odds ratio [OR] 1.006; 95% confidence interval [CI] 1.002–1.011; p = 0.001], white blood cell count (OR 1.129; 95% CI 1.044–1.220; p = 0.002), and shock (OR 4.504; 95% CI 1.774–11.435; p = 0.002) were independent predictors of nosocomial BSI, allowing distinction of patients with the infection from those without. The area under the ROC curve for the albumin:PCT ratio was 0.830 (95% CI 0.768–0.892; p < 0.001). The cut-off value of the albumin:PCT ratio was <1.087 with a sensitivity of 90.6% and a specificity of 98.8%. In the subgroup of 85 patients with nosocomial BSI, the albumin:PCT ratio in patients with shock was lower than that in those without shock (7.154 [2.975–26.267] vs 28.000 [3.818–57.812]; p = 0.027).

Conclusion:

The albumin:PCT ratio can be used as an early diagnostic predictor for nosocomial BSI in patients with ICH. Additionally, BSI patients with lower albumin:PCT ratios are more likely to experience shock. The albumin:PCT ratio is expected to be a rapid and low-cost tool for clinical practice.