Abstract
BackgroundThe difficulty of early diagnosis of bloodstream infection in the elderly patients leads to high mortality. Therefore, it is essential to determine some new methods of early warning of bloodstream infection in the elderly patients for timely adjustment of treatment and improvement of prognosis.MethodsPatients aged over 65 years with suspected bloodstream infections were included and divided into bloodstream infection (BSI) and non-bloodstream infection (non-BSI) groups based on blood culture results. The morphology of microparticles (MPs) was observed by using transmission electron microscopy, and the number of MPs was dynamically monitored by flow cytometry.ResultsA total of 140 patients were included in the study: 54 in the BSI group and 86 in the non-BSI group. Total MPs (T-MPs) ≥ 6000 events/µL (OR, 7.693; 95% CI 2.944–20.103, P < 0.0001), neutrophil-derived MPs (NMPs) ≥ 500 events/µL (OR, 12.049; 95% CI 3.574–40.623, P < 0.0001), and monocyte counts ≤ 0.4 × 109/L (OR, 3.637; 95% CI 1.415–9.348, P = 0.007) within 6 h of fever were independently associated with bloodstream infection in the elderly patients. We also developed an early warning model for bloodstream infection in the elderly patients with an area under the curve of 0.884 (95% CI 0.826–0.942, P < 0.0001), sensitivity of 86.8%, specificity of 76.5%, positive predictive value of 70.8%, and negative predictive value of 89.8%.ConclusionThe early warning model of bloodstream infection based on circulating T-MPs, NMPs, and monocyte counts within 6 h of fever in the elderly patients was helpful in early detection of bloodstream infection and therefore promptly adjustment of treatment plan.
Highlights
As a critical illness, the morbidity and mortality of bloodstream infection increase with age
Receiver operating characteristic (ROC) curve to evaluate the predictive value of early warning model for predicting bloodstream infection in the elderly population The ROC curve showed that the area under the curve (AUC) of the early warning model for predicting bloodstream infection in the elderly population was 0.884, the optimal cutoff value of Y was 3.5, the sensitivity was 86.8%, the specificity was 76.5%, the positive predictive value was 70.8%, and the negative predictive value was 89.8% (Table 4, Fig. 2)
MPs have been shown to be associated with infection [11, 13, 14], and we found that MPs of all cellular origins were significantly increased within 6 h of infection in elderly patients and gradually decreased with treatment and improvement of infection, suggesting that MPs are associated with the occurrence and prognosis of infection
Summary
The morbidity and mortality of bloodstream infection increase with age. Liu et al Ann. Intensive Care (2021) 11:110 suitable biomarkers for early warning of bloodstream infections in the elderly patients may reduce the mortality and morbidity of this critical condition. MPs are derived from various types of circulating cells and involved in promoting coagulation, cell adhesion, chemotaxis, and release of various inflammatory factors and have been reported to contribute to the early diagnosis of sepsis-induced disseminated intravascular coagulation [10, 11]. The difficulty of early diagnosis of bloodstream infection in the elderly patients leads to high mortality. It is essential to determine some new methods of early warning of bloodstream infection in the elderly patients for timely adjustment of treatment and improvement of prognosis
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