The intensive care infection score – a novel marker for the prediction of infection and its severity

Abstract

BackgroundThe prediction of infection and its severity remains difficult in the critically ill. A novel, simple biomarker derived from five blood-cell derived parameters that characterize the innate immune response in routine blood samples, the intensive care infection score (ICIS), could be helpful in this respect. We therefore compared the predictive value of the ICIS with that of the white blood cell count (WBC), C-reactive protein (CRP) and procalcitonin (PCT) for infection and its severity in critically ill patients.MethodsWe performed a multicenter, cluster-randomized, crossover study in critically ill patients between January 2013 and September 2014. Patients with a suspected infection for which blood cultures were taken by the attending intensivist were included. Blood was taken at the same time for WBC, ICIS, CRP and PCT measurements in the control study periods. Results of imaging and cultures were collected. Patients were divided into groups of increasing likelihood of infection and invasiveness: group 1 without infection or with possible infection irrespective of cultures, group 2 with probable or microbiologically proven local infection without blood stream infection (BSI) and group 3 with BSI irrespective of local infection. Septic shock was assessed.ResultsIn total, 301 patients were enrolled. CRP, PCT and ICIS were higher in groups 2 and 3 than group 1. The area under the receiver operating characteristic curve (AUROC) for the prediction of infection was 0.70 for CRP, 0.71 for PCT and 0.73 for ICIS (P < 0.001). For the prediction of septic shock the AUROC was 0.73 for CRP, 0.85 for PCT and 0.76 for ICIS. These AUROC did not differ from each other.ConclusionThe data suggest that the ICIS is potentially useful for the prediction of infection and its severity in critically ill patients, non-inferiorly to CRP and PCT. In contrast to CRP and PCT, the ICIS can be determined routinely without extra blood sampling and lower costs, yielding results within 15 minutes.Trial registrationClinicalTrials.gov identifier: ID NCT01847079. Registered on 24 April 2013.

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“…Scores for predicting infection and its severity26 and for the differential diagnosis of infectious and non-infectious process in the ICU27 have been recently published.…”

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“…A mean ICIS value of < 3 (lower cut-off level) indicates the absence of infection. In contrast to CRP and PCT measurements, the ICIS can be determined routinely without new blood sampling and lower costs, yielding results within 15 min[ 53 ].…”

Diagnosing and Managing Sepsis by Probing the Host Response to Infection: Advances, Opportunities, and Challenges

“…A more nuanced assessment of white cell morphological changes in sepsis may provide greater diagnostic value. Several cell parameters have been proposed; the most-studied are the monocyte distribution width (MDW) (24) and the intensive care infection score (ICIS) (25), which measures several cell counts and parameters at once. Both have been prospectively validated as markers of disease severity but not as diagnostics of infection; alternately stated, they can discriminate between simple infections and sepsis but not between infectious and noninfectious inflammation.…”