Lab Med Online.  2012 Oct;2(4):197-203.

Diagnostic Usefulness of Basic Hematologic Tests for the Detection of Bacteremia in Febrile Patients with Neutrophilia

• Cho YU
• Kang JY
• Chae JD
• Son BK

Abstract

BACKGROUND
Alterations in blood cell count are well recognized features of bacteremia. The study objective was to determine the hematologic changes predictive of bacteremia.
METHODS
We retrospectively studied febrile adult patients with neutrophilia and included patients were either bacteriologically proven cases or those who had clinically suspected bacterial infections. Hematologic findings derived from basic hematologic tests were compared between patients with and those without bacteremia.
RESULTS
Of the 624 patients, 143 (22.9%) had significant bacteremia. The following items were significantly different between patients with and those without bacteremia by univariate analysis: absolute neutrophil count, neutrophil differential, absolute lymphocyte count, lymphocyte differential, platelet count and band-associated parameters such as absolute band neutrophil count (ABC). Multivariate analysis revealed platelet count, lymphocyte differential and ABC as independent predictors (P<0.0001, each). Platelet count, the most potent predictor of bacteremia, showed area under the curve (AUC) of 0.685. Analysis according to the primary diagnosis indicated that the most potent predictors of bacteremia in patients with respiratory tract, urinary tract and hepatobiliary system infections were platelet count (P=0.002, AUC=0.697), ABC (P=0.002, AUC=0.681) and neutrophil differential (P=0.0001, AUC=0.822), respectively.
CONCLUSIONS
Simple variables obtained from basic hematologic tests were associated with bacteremia even in febrile patients with neutrophilia. In particular, very high neutrophil differential was highly predictive of bacteremia in patients with hepatobiliary system infections and its clinical usefulness needs to be elucidated in a prospective study.

Keyword

Bacteremia; Neutrophilia; Platelet count; Band neutrophil; Neutrophil differential; Hepatobiliary system infection

MeSH Terms

Adult
Bacteremia
Bacterial Infections
Blood Cell Count
Hematologic Tests
Humans
Lymphocyte Count
Lymphocytes
Multivariate Analysis
Neutrophils
Platelet Count
Respiratory System
Retrospective Studies
Urinary Tract

Figure

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  Fig. 1 ROC curve of neutrophil differential for the discrimination of bacteremic and non-bacteremic status in patients with hepatobiliary system infections. Areas under the ROC curve were 0.822 (95% confidence interval, 0.731 to 0.892). The sensitivity and specificity was 90.0% (95% confidence interval, 73.5 to 97.9) and 67.2% (95% confidence interval, 54.6 to 78.2), respectively, at the optimum cut-off level of 88.6%.

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