Identifying patients with bacterial infections using a combination of C-reactive protein, procalcitonin, TRAIL, and IP-10 in the emergency department: a prospective observational cohort study

Abstract

Objectives: The aim was to effectively reduce the unnecessary use of broad spectrum antibiotics in the emergency department (ED), patients with bacterial infections need to be identified accurately. We investigated the diagnostic value of a combination of biomarkers for bacterial infections, C-reactive protein (CRP), and procalcitonin (PCT), together with biomarkers for viral infections, tumour necrosis factor-related apoptosis-inducing ligand (TRAIL), and interferon-gamma-induced protein-10 (IP-10), in identifying suspected and confirmed bacterial infections in a general ED population with fever. Methods: This is a sub-study in the HiTEMP cohort. Patients with fever were included during ED triage, and blood samples were obtained. Using both diagnostics and expert panel analysis, all patients were classified as having either suspected or confirmed bacterial infections, or non-bacterial disease. Using multivariable logistic regression analysis, three biomarker models were analysed: model 1, CRP, TRAIL, IP-10; model 2, PCT, TRAIL, IP-10; and model 3, CRP, PCT, TRAIL, IP-10. Results: A total of 315 patients were included, of whom 228 patients had a suspected or confirmed bacterial infection. The areas under the curve for the combined models were the following: model 1, 0.730 (95% CI 0.665e0.795); model 2, 0.748 (95% CI 0.685e0.811); and model 3, 0.767(95% CI 0.704 e0.829). Conclusions: These findings show that a combination of CRP, PCT, TRAIL and IP-10 can identify bacterial infections with higher accuracy than single biomarkers and combinations of a single bacterial biomarkers combined with TRAIL and IP-10. Y. van der Does,

Development of Prediction Models for New Integrated Models and a Bioscore System to Identify Bacterial Infections in Systemic Lupus Erythematosus

“…P values were calculated by the independent samples t-test or the Mann-Whitney U test. sensitive to the risk of bacterial infections (Santolaya et al, 2008;Tang et al, 2011;Urbonas et al, 2012a;Urbonas et al, 2012b). Indeed, the levels of IL-6, IL-10, IFN-g, and TNF-a in our study, showed an upward trend.…”

Multiplexed cytokine detection using electrochemical point-of-care sensing device towards rapid sepsis endotyping

“…The presence of TRAIL and IP-10 has been independently used to differentiate viral from bacterial infection. ( Oved et al, 2015 ; van der Does et al, 2016 , 2018 ; van Houten et al, 2017 ). Moreover, the hypothesis that TRAIL participates in sepsis by controlling inflammatory cell apoptosis and promotes inflammation resolution ( Renshaw et al, 2003 ).…”

Host-Based Diagnostics for Acute Respiratory Infections

“…Nevertheless, these results are still better than what has been historically observed with PCT, a finding reported by the test's manufacturer, and which highlights the potential improvements with a multimarker strategy. 67 van der Does et al 68 added to these findings regarding TRAIL/IP-10/CRP in a recently published study. In a cohort of 315 febrile patients in the ED, the 3-protein signature identified bacterial infections with an AUC of 0.73.…”