Gu, Qingze;
Wei, Jia;
Yoon, Chang Ho;
Yuan, Kevin;
Jones, Nicola;
Brent, Andrew;
Llewelyn, Martin;
... Walker, A Sarah; + view all
(2024)
Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection.
Journal of Infection
, 88
(5)
, Article 106156. 10.1016/j.jinf.2024.106156.
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Abstract
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.
| Type: | Article |
|---|---|
| Title: | Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.jinf.2024.106156 |
| Publisher version: | https://doi.org/10.1016/j.jinf.2024.106156 |
| Language: | English |
| Additional information: | Copyright © 2024 The Author(s). Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). |
| Keywords: | Bloodstream infection; C-reactive protein; Vital signs; Trajectory subgroups; Centile chart |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10190173 |
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