Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2020; 26(32): 4857-4865
Published online Aug 28, 2020. doi: 10.3748/wjg.v26.i32.4857
Development of a novel score for the diagnosis of bacterial infection in patients with acute-on-chronic liver failure
Su Lin, Yan-Yan Yan, Yin-Lian Wu, Ming-Fang Wang, Yue-Yong Zhu, Xiao-Zhong Wang
Su Lin, Xiao-Zhong Wang, Department of Gastroenterology, Union Hospital of Fujian Medical University, Fuzhou 350000, Fujian Province, China
Yan-Yan Yan, Yin-Lian Wu, Ming-Fang Wang, Yue-Yong Zhu, Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, Fujian Province, China
Yan-Yan Yan, Clinical Liver Center, The 180th Hospital of People’s Liberation Army, Quanzhou Fujian Province, 362100, China
Author contributions: Lin S designed the study; Wang MF and Yan YY collected and analyzed the data; Lin S, Yan YY and Wu YL drafted the manuscript; Zhu YY and Wang XZ contributed to critical comments of the manuscript; all authors approved the final version of the manuscript prior to submission.
Supported by the Chinese National Science and Technology Projects, No. 2017ZX10202201.
Institutional review board statement: The study was approved by the Ethics Committee of the First Affiliated Hospital of Fujian Medical University.
Informed consent statement: All patients hospitalized in the First Affiliated Hospital of Fujian Medical University sign a written consent for anonymous use of digital data for scientific research. We are not able to present each document of the included 386 cases. An example of the consent is shown below.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: Not available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Zhong Wang, MD, PhD, Chief Doctor, Department of Gastroenterology, Union Hospital of Fujian Medical University, No. 29 Shengmiao Road, Gulou, Fuzhou 350000, Fujian Province, China. drwangxz@163.com
Received: May 23, 2020
Peer-review started: May 23, 2020
First decision: June 12, 2020
Revised: June 18, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: August 28, 2020
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.

Keywords: Acute on chronic liver failure, Bacterial infection, Score

Core tip: This is a retrospective study evaluating the diagnostic value of widely used biomarkers for infection, including procalcitonin (PCT), white blood cells, proportion of neutrophils (N%), and C-reactive protein (CRP) for bacterial infection in ACLF. The results showed that all four parameters did not perform well in ACLF, with no significant difference found among them. A novel scoring system was developed comprised of N%, PCT and CRP which demonstrated higher accuracy for bacterial infection in ACLF than the indicators used alone. Further validation of this scoring system is required in prospective studies.