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Pyo, Yoon, Kim, Chae, and Lee: Clinical usefulness of procalcitonin/albumin and blood urea nitrogen/albumin ratios for the early detection of bacteremia
Original article

Ann Clin Microbiol 2023;26(4):103-115.

Published online: 20 December 2023

DOI: https://doi.org/10.5145/ACM.2023.26.4.103

Clinical usefulness of procalcitonin/albumin and blood urea nitrogen/albumin ratios for the early detection of bacteremia

Sang Shin Pyo1, 2, Dae Wui Yoon1, 2, Hyunjung Kim3, Hiun Suk Chae4, Hae Kyung Lee3

1Department of Biomedical Laboratory Science

2Sleep Medicine Institute, Jungwon University, Goesangun, Chungbuk

3Departments of 3Laboratory Medicine

4Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea

Corresponding author: Hae Kyung Lee E-mail: hkl@catholic.ac.kr

Received 30 August 2023       Revised 21 September 2023       Accepted 26 October 2023

© Korean Society of Clinical Microbiology. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Early prediction of bacteremia is important because sepsis may develop if bacteremia is not treated in time. We aimed to determine whether blood tests are clinically useful in predicting gram-negative versus gram-positive bacteremia. Methods: We retrospectively analyzed the medical records of 16,569 patients who underwent blood culture testing among those who visited St. Mary’s Hospital of Uijeongbu, Catholic University from January 1, 2018 to December 31, 2018. After excluding 15,580 patients with insufficient data for analysis, the total study population was 989. Results: In the multivariable logistic regression analysis for gram-negative bacteremia, after adjusting for major variables, procalcitonin (odds ratio [OR] 1.02, P < 0.001), high-sensitivity C-reactive protein (OR 1.03, P = 0.010), and albumin (OR 0.55, P = 0.010) were significant. In the same model, lactic acid (OR 1.08, P = 0.010), blood urea nitrogen (BUN) (OR 1.02, P = 0.010), and albumin (OR 0.50, P = 0.005) were significant for gram-positive bacteremia. We constructed blood indicators by combining blood tests that were significant in multivariable logistic regression analysis. Comparing the area under the curve (AUC) of the receiver operating characteristic curve, the AUC of the procalcitonin/albumin ratio in gramnegative bacteremia was significantly higher than that of procalcitonin (0.846 vs. 0.837, P = 0.005), and the AUC of the BUN/albumin ratio in gram-positive bacteremia was significantly higher than that of BUN (0.709 vs. 0.679, P = 0.007). Conclusion: The procalcitonin/albumin ratio is expected to be helpful in the early prediction of gram-negative bacteremia, whereas the BUN/albumin ratio in the early prediction of grampositive bacteremia.

Keywords: Bacteremia, Sepsis, Albumin, Procalcitonin, Blood urea nitrogen

[in Korean]

Ethics statement

This study was approved by the institutional review board of Uijeongbu St. Mary's Hospital (IRB No. UC19RESI0110). The board exempted the obtainment of informed consent.

Conflicts of interest

No potential conflicts of interest relevant to this article were reported.

Funding

None.

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Fig. 1.
Flow chart of research samples.
ACM-2604-03-f1.png
Table 1
Baseline characteristics of study patients
ACM-2604-03-t1.png

Data are presented as the mean ± standard deviation or n (%).

Abbreviations: hsCRP, high sensitivity C-reactive protein; BUN, blood urea nitrogen.

Table 2
Logistic regression analysis for relation between bacteremia and biochemical variables
ACM-2604-03-t2.png

*Model 1: adjusted for age, sex; †Model 2: adjusted for age, sex, white blood cell count, platelet count, creatinine, total bilirubin, glucose.

Abbreviations: OR, odds ratio; CI, confidence interval; hsCRP, high sensitivity C-reactive protein; BUN, blood urea nitrogen.

Table 3
Area under the receiver operating characteristic (ROC) curve for predicting Gram-negative bacteremia or Gram-positive bacteremia
ACM-2604-03-t3.png

*Comparison of ROC curves was performed using the Delong method.

Abbreviations: AUC, area under the curve; CI, confidence interval; hsCRP, high sensitivity C-reactive protein; BUN, blood urea nitrogen.

Fig. 2.
The receiver operating characteristic (ROC) curves for the biomarkers evaluated in the present study. (a) ROC for predicting Gram negative bacteremia. (b) ROC for predicting Gram positive bacteremia. AUC, area under the curve; hsCRP, high sensitivity C-reactive protein; BUN, blood urea nitrogen.
ACM-2604-03-f2.png
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