The online version of this article (doi:10.1186/cc9309) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
CPCdeJ and PCW conceived and designed the study. CPCdeJ, PCW, PTLvW and RBM prepared the data for analysis. CPCdeJ, PTLvW and TvdP conducted the qualitative data analysis. PCW was responsible for clinical microbiological analysis of patient materials. CPCdeJ, RBM and PCW abstracted the medical records and assessed for error. JdJ-L and TvdP assisted with the interpretation of the results. CPCdeJ and PCW drafted the article and all authors contributed substantially to its revision. CPCdeJ, TvdP and PCW take responsibility for the paper as a whole.
Absolute lymphocytopenia has been reported as a predictor of bacteremia in medical emergencies. Likewise, the neutrophil-lymphocyte count ratio (NLCR) has been shown a simple promising method to evaluate systemic inflammation in critically ill patients.
We retrospectively evaluated the ability of conventional infection markers, lymphocyte count and NLCR to predict bacteremia in adult patients admitted to the Emergency Department with suspected community-acquired bacteremia. The C-reactive protein (CRP) level, white blood cell (WBC) count, neutrophil count, lymphocyte count and NLCR were compared between patients with positive blood cultures (n = 92) and age-matched and gender-matched patients with negative blood cultures (n = 92) obtained upon Emergency Department admission.
Significant differences between patients with positive and negative blood cultures were detected with respect to the CRP level (mean ± standard deviation 176 ± 138 mg/l vs. 116 ± 103 mg/l; P = 0.042), lymphocyte count (0.8 ± 0.5 × 109/l vs. 1.2 ± 0.7 × 109/l; P < 0.0001) and NLCR (20.9 ± 13.3 vs. 13.2 ± 14.1; P < 0.0001) but not regarding WBC count and neutrophil count. Sensitivity, specificity, positive and negative predictive values were highest for the NLCR (77.2%, 63.0%, 67.6% and 73.4%, respectively). The area under the receiver operating characteristic curve was highest for the lymphocyte count (0.73; confidence interval: 0.66 to 0.80) and the NLCR (0.73; 0.66 to 0.81).
In an emergency care setting, both lymphocytopenia and NLCR are better predictors of bacteremia than routine parameters like CRP level, WBC count and neutrophil count. Attention to these markers is easy to integrate in daily practice and without extra costs.
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- Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit
Cornelis PC de Jager
Paul TL van Wijk
Rejiv B Mathoera
Jacqueline de Jongh-Leuvenink
Tom van der Poll
Peter C Wever
- BioMed Central
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