Abstract
Early changes in biomarker levels probably occur before bloodstream infection (BSI) is diagnosed. However, this issue has not been fully addressed. We aimed at evaluating the kinetics of C-reactive protein (CRP) and plasma albumin (PA) in the 30 days before community-acquired (CA) BSI diagnosis. From a population-based BSI database we identified 658 patients with at least one measurement of CRP or PA from day -30 (D-30) through day -1 (D-1) before the day of CA-BSI (D0) and a measurement of the same biomarker at D0 or D1. Amongst these, 502 had both CRP and PA measurements which fitted these criteria. CRP and PA concentrations began to change inversely some days before CA-BSI diagnosis, CRP increasing by day -3.1 and PA decreasing by day -1.3. From D-30 to D-4, CRP kinetics (expressed as slopes - rate of concentration change per day) was -1.5 mg/l/day. From D-3 to D1, the CRP slope increased to 36.3 mg/l/day. For albumin, the slope between D-30 to D-2 was 0.1 g/l/day and changed to -1.8 g/l/day between D-1 and D1. We showed that biomarker levels begin to change some days before the CA-BSI diagnosis, CRP 3.1 days and PA 1.3 days before.
Highlights
Changes in biomarkers probably occur some days before bloodstream infection (BSI) is diagnosed
C-reactive protein (CRP) and plasma albumin (PA) concentrations began to change inversely some days before CA-BSI diagnosis, CRP increasing by day −3.1 and PA decreasing by day −1.3
The broken stick regression (BSR) analysis showed that CRP began to increase at day −3.1 (Fig. 2, upper panel, arrow)
Summary
Changes in biomarkers probably occur some days before bloodstream infection (BSI) is diagnosed. This issue has not been fully addressed in previous clinically based studies, in particular in community-acquired (CA) infections [1,2,3,4]. Hospital-acquired infections frequently occur in patients with other non-infectious conditions that are associated with increased biomarker levels, e.g. previous surgery or IV lines. We are unable to obtain the microbiological documentation of an infection. This is true in CA infections, e.g. due to previous antibiotics prescriptions and difficulty in obtaining good quality samples for microbiology, in particular in lower respiratory tract infections in patients without tracheal intubation. CA-BSI is a well-defined clinical entity based on clear and globally accepted clinical and microbiological diagnostic criteria [5]
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