Deniz Emre, Klatte Stefanie, Tekin-Bubenheim Nilgün, Zimmermann Mathias
Institute of Laboratory Medicine, DRK Kliniken Berlin Westend, Spandauer Damm 130, 14050, Berlin, Germany.
Medical Science Department, Sysmex Europe SE, Bornbarch 1, 22848, Norderstedt, Germany.
Intensive Care Med Exp. 2025 Jun 5;13(1):58. doi: 10.1186/s40635-025-00767-3.
Diagnosis of infectious inflammation is challenging as acute phase protein expression is nonspecific, limiting the utility of well-established biomarkers, such as procalcitonin (PCT) and C-reactive protein (CRP). The emergent blood cell-derived Intensive Care Infection Score (ICIS) is an innovative approach for the sensitive and specific diagnosis of infection in intensive care unit (ICU) patients. This study aimed to confirm the suitability of routine ICIS use in various ICU settings.
This retrospective study included 115 patients from three ICUs. Seventy-five patients were diagnosed as infected and 40 as uninfected. ICIS, CRP, and PCT were compared to routine clinical assessment to evaluate their effectiveness in predicting infection in critically ill patients.
ICIS was superior to CRP and PCT in discriminating infection from no infection on day 1 in the ICU. In receiver operating characteristic curve analysis, ICIS exhibited an AUC = 0.984, sensitivity of 90.7%, specificity of 97.5%, positive predictive value (PPV) of 97.7% and negative predictive value (NPV) of 89.9%, by the best cutoff value of 3. CRP gave an AUC = 0.727, PPV of 70.0% and NPV of 67.8% by best cutoff value of 8.3 mg/L with a sensitivity of 74.7% and specificity of 62.5%. The best cutoff value of 0.9 ng/mL was calculated for PCT with an AUC = 0.812, PPV of 84.4%, NPV of 70.3%, sensitivity of 69.3% and specificity of 85.0%.
ICIS outperformed CRP and PCT in identifying infection in critically ill patients across different ICU settings on the first day in the ICU. The high NPV emphasizes the potential of ICIS as an adjuvant tool to rule out infections thereby facilitating the reduction of antibiotic overuse and consequently limiting antimicrobial resistance (AMR) development. ICIS appears suitable for routine implementation in various ICU settings.
感染性炎症的诊断具有挑战性，因为急性期蛋白表达不具有特异性，这限制了降钙素原（PCT）和C反应蛋白（CRP）等成熟生物标志物的应用。新出现的血细胞衍生重症监护感染评分（ICIS）是一种用于重症监护病房（ICU）患者感染敏感且特异诊断的创新方法。本研究旨在确认在各种ICU环境中常规使用ICIS的适用性。
这项回顾性研究纳入了来自三个ICU的115名患者。75名患者被诊断为感染，40名未感染。将ICIS、CRP和PCT与常规临床评估进行比较，以评估它们在预测危重症患者感染方面的有效性。
在ICU的第1天，ICIS在区分感染与未感染方面优于CRP和PCT。在受试者工作特征曲线分析中，ICIS的曲线下面积（AUC）=0.984，灵敏度为90.7%，特异度为97.5%，阳性预测值（PPV）为97.7%，阴性预测值（NPV）为89.9%，最佳临界值为3。CRP的AUC=0.727，最佳临界值为8.3mg/L时，PPV为70.0%，NPV为67.8%，灵敏度为74.7%，特异度为62.5%。PCT的最佳临界值为0.9ng/mL，AUC=0.812，PPV为84.4%，NPV为70.3%，灵敏度为69.3%，特异度为85.0%。
在ICU的第一天，ICIS在识别不同ICU环境中的危重症患者感染方面优于CRP和PCT。高NPV强调了ICIS作为辅助工具排除感染的潜力，从而有助于减少抗生素的过度使用，进而限制抗菌药物耐药性（AMR）的发展。ICIS似乎适用于在各种ICU环境中常规实施。
