Development of a novel score for the diagnosis of bacterial infection in patients with acute-on-chronic liver failure

Abstract

BACKGROUND The diagnosis of bacterial infection is difficult in patients with acute-on-chronic liver failure (ACLF). AIM To evaluate the diagnostic accuracy of widely used parameters for bacterial infection in ACLF and to develop a simple scoring system to improve diagnostic efficiency. METHODS This was a retrospective study. Procalcitonin (PCT), white blood cells (WBC), proportion of neutrophils (N%), and C-reactive protein (CRP) were examined. Logistic regression was used to select variables for the scoring models and receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic value of different indices. RESULTS This study included 386 patients with ACLF, 169 (43.78%) of whom had bacterial infection on admission. The area under the ROC (AUROC) of PCT, CRP, WBC and N% for the diagnosis of bacterial infection ranged from 0.637 to 0.692, with no significant difference between them. Logistic regression showed that only N%, PCT, and CRP could independently predict infection. A novel scoring system (infection score) comprised of N%, PCT and CRP was developed. The AUROC of the infection score was 0.740, which was significantly higher than that for the other four indices (infection score vs N%, PCT, CRP, and WBC, P = 0.0056, 0.0001, 0.0483 and 0.0008, respectively). The best cutoff point for the infection score was 4 points, with a sensitivity of 78.05%, a specificity of 55.29%, a positive predictive value of 57.91% and a negative predictive value of 76.16%. CONCLUSION The infection score is a simple and useful tool for discriminating bacterial infection in ACLF.

[Retracted] To Investigate the Effect of Magnetic Resonance Imaging (MRI) and Diffusion Tensor Imaging (DTI) in the Diagnosis of Mild Craniocerebral Injury

“…However, there was no significant difference between NAA/Cr in pons and long brain and NAA/CHO and CHO/Cr in thalamus and normal control group Correlation analysis between MRI parameters and clinical data after the correlation analysis with poor clinical outcomes at follow-up, it was found that CHO/Cr only showed correlation with prognosis in mild brainstem ARAS, and the other two items were correlated with prognosis score in acute stage and mild stage. Except that NAA/CHO in the thalamus in the acute stage did not show significant prognostic correlation, the parameters of other regions of interest showed good correlation with prognosis (Tables 10 – 12 ) [ 19 ]. …”

Diagnostic Accuracy of Procalcitonin for Bacterial Infection in Liver Failure: A Meta-Analysis

“…A total of 480 relevant literatures were retrieved. After reviewing the titles, abstracts, and full text, the literatures that did not meet the inclusion criteria were excluded, and six articles were finally included [20][21][22][23][24][25]. ese studies included 432 liver failure patients without bacterial infection, with 466 (51.89%) confirmed patients with bacterial infection.…”

“…With the continuous progress of understanding of PCT, there are many studies on the accuracy of PCT in the diagnosis of liver cirrhosis complicated with bacterial infection [17][18][19]. However, the value of using PCT levels for early detection of bacterial infections in patients with liver failure is controversial [20,21]. Furthermore, there is still a lack of meta-analysis regarding the accuracy of PCT in the diagnosis of bacterial infections complicating liver failure.…”

Value of Soluble CD14 (Presepsin) in Diagnosis of Bacterial Sepsis in Patients with Chronic Liver Disease

“…However, other studies mentioned that the most frequent types were pneumonia, UTI and bacteremia 6 , SBP, UTI, pneumonia and bacteremia 23 , and UTI, SBP, and pneumonia 22 . Moreover, pneumonia, SBP, UTI and bacteremia were the most common types in acute on chronic liver failure (ACLF) patients 24 . This variation may be accounted for by disparities in demographic characteristics and number of the studied patients.…”