Abstract

Early bacterial infection (BI) identification in resource-limiting Emergency Departments (ED) is challenging, especially in low- and middle-income counties (LMIC). Misdiagnosis predisposes to antibiotic overuse and propagates antimicrobial resistance. This study evaluates new emerging biomarkers, secretory phospholipase A2 group IIA (sPLA2-IIA) and compares with other biomarkers on their performance characteristic of BI detection in Malaysia, an LMIC. A prospective cohort study was conducted involving 151 consecutive patients admitted to the ED. A single measurement was taken upon patient arrival in ED and was analysed for serum levels of sPLA2-IIA, high-sensitive C-reactive protein (CRP), procalcitonin (PCT), neutrophil percentage (N%), and lactate. All biomarkers’ performance was compared for the outcomes using area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. The performance of sPLA2-IIA (AUROC 0.93 [95% CI: 0.89–0.97]; Sn 80% [95% CI: 72–87]; Sp 94% [95% CI: 81–89]) was the highest among all. It was comparable with high-sensitive CRP (AUROC 0.93 [95% CI: 0.88–0.97]; Sn 75% [95% CI: 66–83]; Sp 91 [95% CI: 77–98]) but had a higher Sn and Sp. The sPLA2-IIA was also found superior to N%, PCT, and lactate. This finding suggested sPLA2-IIA was recommended biomarkers for BI detection in LMIC.

Highlights

  • The Global Burden of Disease Study reported that infection caused more than 10 million lives lost per ­year[1]

  • The MedCalc online calculator was used to determine Sn, Sp, positive predictive values (PPV), negative predictive values (NPV), and accuracy with a 95% confidence interval (95%CI) of each biomarker

  • The age for bacterial infection (BI) appeared older as compared with the non-bacterial infection (NBI) group (p = 0.008)

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Summary

Introduction

The Global Burden of Disease Study reported that infection caused more than 10 million lives lost per ­year[1]. The biggest drawback is the significant turnaround time of approximately 24–48 h to isolate the causative agents This time-intensive limitation had become the disadvantages for blood culture and rendering it impracticable at ED for its triage r­ esponsibility[7,8]. For the new emerging biomarkers, secretory phospholipase A2 group IIA (sPLA2-IIA) was hypothesised able to distinguish BI, but few studies were available, requiring further ­validation[12,13]. This prospective study aimed to investigate the performance of new emerging biomarker sPLA2-IIA with other biomarkers inclusive of high-sensitive CRP, PCT, N%, and lactate in their diagnostic value to identify BI from NBI

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