C-reactive protein and albumin kinetics before community-acquired bloodstream infections – a Danish population-based cohort study

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.

Which Biomarkers Can Be Used as Diagnostic Tools for Infection in Suspected Sepsis?

“…16 More recently, from a population-based BSI database, we showed that CRP and plasma albumin (PA) concentrations began to change inversely some days before CA-BSI diagnosis, CRP increasing by day À3.1, and PA decreasing by day À1.3. 17 In addition, in a population-based study of acute myeloid leukemia, we also found that serial CRP measurements remain steadily low in the absence of infectious complications. 42 Other studies in different clinical settings showed similar findings.…”

“…16 More recently, Garvik et al showed that in patients with blood stream infections (BSIs), CRP presented a significant rise (slope increase to 3.63 mg/dL/d) 3.1 days before BSI diagnosis (defined as the day of positive blood cultures). 17 On the contrary, PCT kinetics before infection diagnosis showed poor diagnostic performance in several studies. Luyt et al in a previous study assessing the course of PCT before VAP diagnosis, both the crude PCT values and its kinetics, showed poor diagnostic accuracy.…”

Pancreatic Stone Protein: Review of a New Biomarker in Sepsis

“…PSP demonstrates a significant interaction between time and presence of sepsis [46,47], suggesting that besides a fixed cut-off value (as in standard ROC curve analysis) the timerelated kinetics of PSP has a crucial role in the identification of sepsis when considering the time-dependency of the infectious/septic event. CRP had also shown usefulness in the timely stratification of the risk of infection in critically ill patients (patients presenting maximum daily CRP variation >4.1 mg/dL plus a CRP level >8.7 mg/dL had an 88% risk of ICU-acquired infection [54]), in prediction of VAP in the first six days of mechanical ventilation (rate of CRP change per day, highest level and maximum amplitude of variation were all significantly associated with VAP development [55]), and in anticipation of community-acquired bloodstream infection (CRP concentrations began to increase 3.1 days before diagnosis [56]). Such an approach of time-profiling a biomarker may be more helpful, informative and accurate [47].…”

A new possibility: gene-expression-based diagnostics for presymptomatic diagnosis of hospital-acquired infections

“…The hypothesis is that early deviations in informative biomarkers may allow for early treatment of postoperative infections, thereby sparing the patient the downstream complications of undertreated sepsis. This possibility is supported by data showing that serial C-reactive protein or procalcitonin measurements could be used to predict infection in community-acquired as well as in infections acquired in the intensive care unit (ICU) in both medical and surgical patients [5][6][7][8].…”