Procalcitonin,interleukin 6,high-sensitivity C-reactive protein,and neutrophil ratio in the clinical diagnosis of bloodstream infection in acute pyelonephritis
Objective To evaluate the clinical application value of procalcitonin(PCT),interleukin 6(IL-6),high-sensitivity C-reactive protein(hs-CRP),and neutrophil percentage(NEU％)in blood for early diagnosis of bloodstream infection(BSI)in patients with acute pyelonephritis(APN).Methods A total of 67 patients with APN and single-pathogen blood-stream infection hospitalized in Rizhao Central Hospital from January 1,2021,to March 31,2023,were selected as the bloodstream infection group.Additionally,61 APN patients with negative blood cultures hospitalized in the same period were selected as the non-bloodstream infection group.Blood samples collected on the day of blood culture were tested for PCT,IL-6,hs-CRP,and NEU％.The differences in these indicators between the two groups were analyzed using the Mann-Whitney U test.Receiver operating characteristic(ROC)curves were plotted to evaluate the diagnostic value of each indicator individually and in combination for APN with BSI.Results Among the 67 cases of bloodstream infection pathogens,there were 54 strains(80.60％)of Gram-negative bacteria,mainly Escherichia coli and Klebsiella pneumoniae;13 strains(19.40％)of Gram-positive bacteria,mainly Staphylococcus aureus and Streptococcus faecalis.The comparison of infection indicators between the blood culture positive group and the blood culture negative group showed that the ser-um PCT level in the blood culture positive group was significantly higher than that in the blood culture negative group,with a statistically significant difference,P＜0.001.The serum IL-6 level in the blood culture positive group was signifi-cantly higher than that in the blood culture negative group,with a statistically significant difference,P＜0.001.The blood NEU％level in the blood culture positive group was significantly higher than that in the blood culture negative group,with a statistically significant difference,P＜0.001.There was no statistically significant difference in serum hs-CRP levels between the blood culture positive group and the blood culture negative group,P=0.074.ROC curve analysis showed that the AUC for PCT in diagnosing APN with BSI was 0.821,P＜0.001,with a optimal diagnostic cutoff value of 2.06 ng/ml,a sensitivity of 67.2％,and a specificity of 85.2％,with a Youden index of 0.524.The AUC for IL-6 in diagnosing APN with BSI was 0.718,P＜0.001,with a optimal diagnostic cutoff value of 43.76 pg/ml,a sensitivity of 88.1％,and a specificity of 55.7％,with a Youden index of 0.438.The AUC for NEU％in diagnosing APN with BSI was 0.751,P＜0.001,with a optimal diagnostic cutoff value of 82.40％,a sensitivity of 71.6％,and a specificity of 73.8％,with a Youden index of 0.458.The combined detection of PCT,IL-6,and NEU％had an AUC of 0.867,P＜0.001.Conclusion Hs-CRP cannot effectively differentiate between APN with and without BSI;PCT has the highest auxiliary diagnostic value;com-bined detection of multiple indicators can improve the diagnostic efficiency of BSI in APN patients.
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