School of Molecular Cell Biology and Biotechnology, Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences, Tel Aviv University, 6997801, Tel Aviv, Israel.
Department of Internal Medicine "C", "D" and "E", Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, 6423906, Tel Aviv, Israel.
Eur J Clin Microbiol Infect Dis. 2019 Dec;38(12):2331-2339. doi: 10.1007/s10096-019-03682-0. Epub 2019 Sep 6.
The clinical diagnosis of acute infections in the emergency department is a challenging task due to the similarity in symptom presentation between virally and bacterially infected individuals, while the use of routine laboratory tests for pathogen identification is often time-consuming and may contain contaminants. We investigated the ability of various anemia-related parameters, including hemoglobin, red cell distribution width (RDW), and iron, to differentiate between viral and bacterial infection in a retrospective study of 3883 patients admitted to the emergency department with a confirmed viral (n = 1238) or bacterial (n = 2645) infection based on either laboratory tests or microbiological cultures. The ratio between hemoglobin to RDW was found to be significant in distinguishing between virally and bacterially infected patients and outperformed other anemia measurements. Moreover, the predictive value of the ratio was high even in patients presenting with low C-reactive protein values (< 21 mg/L). We followed the dynamics of hemoglobin, RDW, and the ratio between them up to 72 h post emergency department admission, and observed a consistent discrepancy between virally and bacterially infected patients over time. Additional analysis demonstrated higher levels of ferritin and lower levels of iron in bacterially infected compared with virally infected patients. The anemia measurements were associated with length of hospital stay, where all higher levels, except for RDW, corresponded to a shorter hospitalization period. We highlighted the importance of various anemia measurements as an additional host-biomarker to discern virally from bacterially infected patients.
在急诊科，由于病毒感染和细菌感染患者的症状表现相似，临床诊断急性感染具有挑战性，而常规实验室检测用于病原体鉴定通常耗时且可能含有污染物。我们通过回顾性研究调查了各种贫血相关参数（包括血红蛋白、红细胞分布宽度（RDW）和铁）在区分病毒和细菌感染方面的能力，该研究纳入了 3883 名因确诊病毒（n = 1238）或细菌（n = 2645）感染而入住急诊科的患者，这些感染基于实验室检测或微生物培养。我们发现，血红蛋白与 RDW 的比值在区分病毒和细菌感染患者方面具有显著意义，并且优于其他贫血测量指标。此外，即使在 C 反应蛋白值较低（< 21 mg/L）的患者中，该比值的预测价值也很高。我们在急诊科入院后 72 小时内跟踪了血红蛋白、RDW 及其比值的动态变化，观察到病毒和细菌感染患者随时间的变化存在持续差异。进一步的分析表明，与病毒感染患者相比，细菌感染患者的铁蛋白水平更高，而铁水平更低。这些贫血测量指标与住院时间有关，除了 RDW 之外，所有较高的水平都对应着较短的住院时间。我们强调了各种贫血测量指标作为区分病毒和细菌感染患者的额外宿主生物标志物的重要性。
