Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection - 30/04/24
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Summary |
Objectives |
To identify patterns in inflammatory marker and vital sign responses in adult with suspected bloodstream infection (BSI) and define expected trends in normal recovery.
Methods |
We included patients ≥16 y from Oxford University Hospitals with a blood culture taken between 1-January-2016 and 28-June-2021. We used linear and latent class mixed models to estimate trajectories in C-reactive protein (CRP), white blood count, heart rate, respiratory rate and temperature and identify CRP response subgroups. Centile charts for expected CRP responses were constructed via the lambda-mu-sigma method.
Results |
In 88,348 suspected BSI episodes; 6908 (7.8%) were culture-positive with a probable pathogen, 4309 (4.9%) contained potential contaminants, and 77,131(87.3%) were culture-negative. CRP levels generally peaked 1–2 days after blood culture collection, with varying responses for different pathogens and infection sources (p < 0.0001). We identified five CRP trajectory subgroups: peak on day 1 (36,091; 46.3%) or 2 (4529; 5.8%), slow recovery (10,666; 13.7%), peak on day 6 (743; 1.0%), and low response (25,928; 33.3%). Centile reference charts tracking normal responses were constructed from those peaking on day 1/2.
Conclusions |
CRP and other infection response markers rise and recover differently depending on clinical syndrome and pathogen involved. However, centile reference charts, that account for these differences, can be used to track if patients are recovering as expected and to help personalise infection treatment.
Le texte complet de cet article est disponible en PDF.Highlights |
• | We investigated vital sign/laboratory test trajectories in >75,000 suspected bloodstream infections. |
• | Responses differed across specific clinical syndromes and pathogens. |
• | Distinct patterns in CRP included normal, slow and delayed/limited recoveries. |
• | We developed CRP centile charts characterising typical responses to guide individualised management. |
Keywords : Bloodstream infection, C-reactive protein, Vital signs, Trajectory subgroups, Centile chart
Plan
Vol 88 - N° 5
Article 106156- mai 2024 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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