Comparison of sPLA2IIA performance with high-sensitive CRP neutrophil percentage PCT and lactate to identify bacterial infection

• Published in: Scientific reports Vol. 11; no. 1; p. 11369
• Main Authors: Tan, Toh Leong, Kang, Christabel Wan-li, Ooi, Kai Shen, Tan, Swee Thian, Ahmad, Nurul Saadah, Nasuruddin, Dian Nasriana, Ithnin, Azlin, Tajul Arifin, Khaizurin, Heng, Lee Yook, Hassan, Nurul Izzaty, Gan, Kok Beng, Neoh, Hui-min
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 31.05.2021; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308; 692/4017; 692/53; Antimicrobial resistance; Bacterial diseases; Bacterial infections; Biomarkers; C-reactive protein; Emergency medical care; Humanities and Social Sciences; Lactic acid; Leukocytes (neutrophilic); multidisciplinary; Neutrophils; Phospholipase A2; Procalcitonin; Science; Science (multidisciplinary); Serum levels
• DOI: 10.1038/s41598-021-90894-0
• ISSN: 2045-2322

Early bacterial infection (BI) identification in resource-limiting Emergency Departments (ED) is challenging, especially in low- and middle-income counties (LMIC). Misdiagnosis predisposes to antibiotic overuse and propagates antimicrobial resistance. This study evaluates new emerging biomarkers, secretory phospholipase A2 group IIA (sPLA2-IIA) and compares with other biomarkers on their performance characteristic of BI detection in Malaysia, an LMIC. A prospective cohort study was conducted involving 151 consecutive patients admitted to the ED. A single measurement was taken upon patient arrival in ED and was analysed for serum levels of sPLA2-IIA, high-sensitive C-reactive protein (CRP), procalcitonin (PCT), neutrophil percentage (N%), and lactate. All biomarkers’ performance was compared for the outcomes using area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. The performance of sPLA2-IIA (AUROC 0.93 [95% CI: 0.89–0.97]; Sn 80% [95% CI: 72–87]; Sp 94% [95% CI: 81–89]) was the highest among all. It was comparable with high-sensitive CRP (AUROC 0.93 [95% CI: 0.88–0.97]; Sn 75% [95% CI: 66–83]; Sp 91 [95% CI: 77–98]) but had a higher Sn and Sp. The sPLA2-IIA was also found superior to N%, PCT, and lactate. This finding suggested sPLA2-IIA was recommended biomarkers for BI detection in LMIC.