Evaluation of potential biomarkers for the discrimination of bacterial and viral infections

• Published in: Infection Vol. 39; no. 5; pp. 411 - 417
• Main Authors: Chalupa, P., Beran, O., Herwald, H., Kaspříková, N., Holub, M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-10-2011; Springer Nature B.V
• Subjects: Adult; Antibiotics; Bacteria; Bacterial diseases; Bacterial infection; Bacterial Infections - blood; Bacterial Infections - diagnosis; Biomarkers; Calcitonin - blood; Calcitonin Gene-Related Peptide; CAP37 protein; CD14 antigen; Cell number; Clinical and Epidemiological Study; Clinical Medicine; Community-Acquired Infections - blood; Community-Acquired Infections - diagnosis; Czech Republic; Differentiation; Discrimination; Etiology; Evaluation; Family Medicine; Female; gamma -Interferon; General Practice; Histocompatibility antigen HLA; Humans; Hydrocortisone; Infection; Infectious Diseases; Infectious focus; Infectious Medicine; Infektionsmedicin; Interleukin 1; Interleukin 10; Interleukin 12; Interleukin 6; Interleukin 8; Internal Medicine; Klinisk medicin; Leukocytes (neutrophilic); Lymphocytes; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Monocytes; Pneumonia; Predictive Value of Tests; procalcitonin; Prospective Studies; Protein Precursors - blood; Pyelonephritis; Pyelonephritis - blood; Pyelonephritis - diagnosis; Sensitivity and Specificity; Sepsis - blood; Sepsis - diagnosis; Serum levels; Severity of Illness Index; Therapeutic applications; TLR2 protein; TLR4 protein; Toll-like receptors; Tumor necrosis factor- alpha; Urinary Tract - microbiology; Viral infection; Virus Diseases - blood; Virus Diseases - diagnosis; Bacterial infection; Infectious focus; Biomarkers; Evaluation; Discrimination; Viral infection
• ISSN: 0300-8126; 1439-0973; 1439-0973
• DOI: 10.1007/s15010-011-0126-4

Purpose
Timely knowledge of the bacterial etiology and localization of infection are important for empirical antibiotic therapy. Thus, the goal of this study was to evaluate routinely used biomarkers together with novel laboratory parameters in the diagnosis of infection.
Methods
In this prospective study, 54 adult patients with bacterial infections admitted to the Department of Infectious Diseases were included. For comparison, 27 patients with viral infections were enrolled. In these patients, white blood cell (WBC) counts, differential blood counts, serum levels of procalcitonin (PCT), IL-1β, IL-6, IL-8, IL-10, IL-12, TNF-α, IFN-γ, soluble CD14 (sCD14), heparin-binding protein (HBP), cortisol (Cort), and monocyte surface expression of TLR2, TLR4, HLA-DR, and CD14 were analyzed. Also, these biomarkers were evaluated in 21 patients with acute community-acquired bacterial pneumonia (CABP), as well as in 21 patients with pyelonephritis and urosepsis.
Results
The highest sensitivity and specificity (expressed as the area under the curve [AUC]) for bacterial infection were observed in serum concentration of PCT (0.952), neutrophil and lymphocyte counts (0.852 and 0.841, respectively), and serum levels of HBP (0.837), IL-6 (0.830), and Cort (0.817). In addition, the serum levels of IFN-γ and Cort were significantly higher and IL-8 levels were lower in CABP when compared to pyelonephritis or urosepsis.
Conclusions
From the novel potential biomarkers, only PCT demonstrated superiority over the routine parameters in the differentiation of bacterial from viral infections. However, some of the novel parameters should be further evaluated in larger and better characterized cohorts of patients in order to find their clinical applications.