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:
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.
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
Research background

Patients with acute-on-chronic liver failure (ACLF) are prone to have bacterial infection. However, the diagnosis of infection is difficult in the ACLF population due to their specific clinico-pathophysiological features.

Research motivation

Early detection of bacterial infection and timely treatment are crucial in the management of ACLF. Therefore, it is important to identify a new biomarker or to develop a model to improve diagnostic efficiency.

Research objectives

This retrospective study aimed to develop a novel scoring system containing common biomarkers for the identification of bacterial infection in ACLF.

Research 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.

Research 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%.

Research conclusions

The common indicators of infection, including WBC, N%, CRP, and PCT, did not perform well in ACLF as all the AUROCs were less than 0.7 and no differences were found between these indicators. A novel scoring system comprised of N%, PCT and CRP demonstrated higher accuracy for bacterial infection in ACLF than the indicators used alone.

Research perspectives

Further validation of this scoring system is required in prospective studies.