Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection
<p><strong>Objectives:</strong> To identify patterns in inflammatory marker and vital sign responses in adult with suspected bloodstream infection (BSI) and define expected trends in normal recovery.</p> <p><strong>Methods:</strong> We incl...
| Main Authors: | , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2024
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| _version_ | 1811140081832951808 |
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| author | Gu, Q Wei, J Yoon, CH Yuan, K Jones, N Brent, A Llewelyn, M Peto, TEA Pouwels, KB Eyre, DW Walker, AS |
| author_facet | Gu, Q Wei, J Yoon, CH Yuan, K Jones, N Brent, A Llewelyn, M Peto, TEA Pouwels, KB Eyre, DW Walker, AS |
| author_sort | Gu, Q |
| collection | OXFORD |
| description | <p><strong>Objectives:</strong> To identify patterns in inflammatory marker and vital sign responses in adult with suspected bloodstream infection (BSI) and define expected trends in normal recovery.</p>
<p><strong>Methods:</strong> 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.</p>
<p><strong>Results:</strong> 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.</p>
<p><strong>Conclusions:</strong> 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.</p> |
| first_indexed | 2024-04-09T03:59:16Z |
| format | Journal article |
| id | oxford-uuid:f5788204-63df-4662-84bf-f5a19840b99e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-09-25T04:16:19Z |
| publishDate | 2024 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:f5788204-63df-4662-84bf-f5a19840b99e2024-07-20T14:04:33ZDistinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infectionJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:f5788204-63df-4662-84bf-f5a19840b99eEnglishSymplectic ElementsElsevier2024Gu, QWei, JYoon, CHYuan, KJones, NBrent, ALlewelyn, MPeto, TEAPouwels, KBEyre, DWWalker, AS<p><strong>Objectives:</strong> To identify patterns in inflammatory marker and vital sign responses in adult with suspected bloodstream infection (BSI) and define expected trends in normal recovery.</p> <p><strong>Methods:</strong> 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.</p> <p><strong>Results:</strong> 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.</p> <p><strong>Conclusions:</strong> 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.</p> |
| spellingShingle | Gu, Q Wei, J Yoon, CH Yuan, K Jones, N Brent, A Llewelyn, M Peto, TEA Pouwels, KB Eyre, DW Walker, AS Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection |
| title | Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection |
| title_full | Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection |
| title_fullStr | Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection |
| title_full_unstemmed | Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection |
| title_short | Distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection |
| title_sort | distinct patterns of vital sign and inflammatory marker responses in adults with suspected bloodstream infection |
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